We are no longer in the era of underwritten individual health insurance policies for those without access to a group/employer sponsored plan. America now has two options, 1. acquire a plan during open enrollment 2. you must meet specific guidlines to qualify for a special enrollment period. If you are a small employer average age over 45, it may benefit you and your employees to drop the group plan and look into alternative funding options related to the individual insurance market. Right now INHEALTH MUTUAL, a no-prof co-op, is by far the most competitive carrier in the Central Ohio Market. Their no-prof status allows them to retain earnings and lower premiums or beef up plan benefits. A family of 5 (husband and wife in their 50's, 3 kids) with a qualifying event, can grab a $2,000/$4,000 deductible PPO plan from Inhealth for around $1,300/month. Family of 3 (husband and wife in the later half of their 20's, 1 child) with a QE can pick up the the same plan mentioned above for a little over $600/month.
In the employer/groups situation mentioned above, some employees save over 30% on their monthly premium.
Here's how you know if you qualify for special enrollment in May-December 2014. Each QE will require a Trigger Date and Required Documentation.
Termination of employment
Date eligibility for existing Minimum Essential Coverage is lost
Letter from employer on company stationery. Letter must verify date of termination.
Reduction in hours worked
Date eligibility for existing Minimum Essential Coverage is lost
Letter from employer on company stationery. Letter must verify date of reduction in hours.
Divorce
Date eligibility for existing Minimum Essential Coverage is lost
Letter from employer/carrier on company stationery. Letter must verify date coverage was terminated and caused by loss of eligible dependent status
Death of spouse/parent
Date eligibility for existing Minimum Essential Coverage is lost
Letter from employer/carrier on company stationery. Letter must verify date coverage was terminated and caused by loss of eligible dependent status.
Dependent reaching limiting age
Date eligibility for existing Minimum Essential Coverage is lost
Letter from employer/carrier on company stationery. Letter must verify date coverage was terminated and caused by loss of eligible dependent status.
No longer qualify for Medicaid or Children's Health Insurance Program (CHIP)¹
Date eligibility for existing Minimum Essential Coverage is lost
Termination of coverage letter for Medicaid or CHIP. Letter must include termination date.
Expiration of COBRA benefits
Date eligibility for existing Minimum Essential Coverage is lost
Documentation of COBRA expiration. Letter must include termination date.
Marriage¹ (addition of spouse)
Date of marriage
Marriage license
Birth² (addition of new child)
Date of birth
None (date of birth should be entered on application)
Adoption² (addition of new child)
Date of adoption
Adoption papers/legal guardianship papers
Placement for adoption
Date of placement
Adoption papers/legal guardianship papers
Placement into foster home²
Date of placement
Legal guardianship papers
New permanent resident of Ohio
Date of permanent move
Documentation required for both prior and new address: • Utility bill • Lease agreement • Mortgage paperwork • Letter from employer if move based on employment
Newly ineligible for federal subsidy³
Date notified of new eligibility status
Newly ineligible for subsidy, the individual may apply in the off-exchange market. Medical Mutual will require termination of subsidy document, which must include the date the subsidy will terminate.
Existing individual policy being terminated¹ (not including termination in case of rescission)
Date policy will be terminated
Copy of termination letter, which displays date of termination.
Existing individual policy renewal date¹
Date renewal is effective
Copy of renewal, which displays renewal effective date.
(*QE List pulled from terms and conditions based on Medical Mutual of Ohio)
"Guiding Individuals and Businesses Through Times of Change"
