March 19, 2014


The open enrollment period cutoff date for individual health insurance in New York State both on and off exchange is 3/31/14.

Come 4/1/14, individuals will not be able to obtain or alter their current insurance until Nov 15th for a 1/1/15 change date.

Any enrollment submitted from now until 3/31/14 will have a 5/1/14 effective date.

The only way to enroll or change individual health insurance after the deadline is to qualify for a Special Enrollment Period through one or more criterion.

We translated it from “legalese” so it’s easier to read, but feel free to read the law verbatim here: Title 45, Subtitle A, Subchapter B, Part 155, Subpart E, Section 155.420

There are 9 distinct events that can generate a SEP:

1. No-fault loss of Minimum Essential Coverage (Employer offered, Medicaid, or Chip)

2. Gaining a dependent through birth/ marriage/ adoption.

3. Gaining status as a citizen/ foreign national/ lawfully present alien.

4. You are a qualified individual who experienced an enrollment issue (subject to review, and can’t be the insured’s fault).

5. Change in income that makes an individual NEWLY eligible for subsidy, or a change in Cost Sharing Reductions (CSR) (specifically, a change in the amount of subsidy doesn’t count).

6. A permanent move of residence that offers new plan options.

7. Adequately prove to the exchange that the Insurer “substantially violated a material provision of it’s contract”.

8. Individual is an Indian (Native American, with government approved proof).

9. “Other exceptional circumstances, as determined by the Exchange or HHS” (I.E. a child with cancer will die if the plan can’t be switched).