What is a qualifying event?
A qualifying event is a life-change that makes you eligible within 60 days of the event to change your health insurance coverage outside the annual enrollment period. Life changes might include a marriage, birth, adoption, death, divorce, loss of coverage due to reduction in work hours, loss of job, relocation, or loss of student insurance or Medicaid. It is not a voluntary loss of coverage or due to non-payment. If you need clarification, please contact us at 800-282-1526 or email@example.com.
How do I know if I need a group health plan or an individual plan?
If you are an employee at an office that does not offer health coverage, you probably need an individual health plan. The Affordable Care Act includes a mandate for most individuals to have health insurance or potentially pay a penalty for noncompliance. For 2016 and beyond the noncompliance penalty is $695 per uninsured person or 2.5 percent of household income over the filing threshold.
If you are an employer who wants to offer a health plan to your office, you probably need a group health plan. More and more employers who are being asked by their employees for help in meeting the health coverage mandate are establishing tax-advantaged employer plans. If you need clarification, please contact us at 800-282-1526 or firstname.lastname@example.org.
What are the laws/rules concerning keeping adult children (over the age of 21) on a family policy?
If a plan covers children, they generally can be added to or kept on a parent's health insurance policy until they turn 26 years old. Adult children can join or remain on a parent's plan even if they are:
- Not living with their parents
- Attending school
- Not claimed as a dependent on their parent’s tax return
- Eligible to enroll in their employer’s plan
*These rules apply to both job-based plans and individual plans bought inside or outside the Marketplace.
When an adult child reaches the plan’s age maximum, what happens?
The adult child who is reaching the maximum age limit will lose coverage at the end of his or her birthday month.
Loss of existing coverage because of age triggers a special open enrollment period. The open enrollment window begins 60 days before the coverage ends, and continues for 60 days after it ends. The applicant will receive proof of coverage loss from his or her current carrier and should begin applying for new coverage at the start of the open enrollment period. Remember that enrolling during the 60 days after the existing policy ends will result in a gap in coverage.
What is a Health Savings Account (HSA)?
Health Savings Accounts (HSAs) are a tax-advantaged medical savings account tied to a high-deductible health plan. Funds contributed to an HSA account are not subject to federal income tax at the time of deposit. HSA funds can be used to pay your deductible as well as help pay for services not covered by your health plan. Unlike a flexible spending account (FSA), HSA funds roll over and accumulate year to year if not spent. After retirement any existing HSA funds can be used for medical and long-term care expenses.