When can I enroll in an individual plan?
Based on the Affordable Care Act regulations, individual insurance plans hold an open enrollment period in the fall. Alternatively, if you have a qualifying event you may enroll within 60 days of the date of the event.
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. Proof of qualifying event is required to be submitted at the time of application. Please click here for a list of acceptable events and the required documentation.
How can I know which health care plans my doctor accepts?
Please check our provider directory to see which health care plan lists your current doctor.
Can I be on an individual plan and have my employer pay the premium or reimburse me?
The IRS no longer permits employers to reimburse employees for individual health insurances premiums. Paying directly for an employee's individual health insurance plans puts the employer out of compliance with IRS regulations and may subject them to a $100/day excise tax per applicable employee (which is $36,500 per year, per employee) under section 4980D of the Internal Revenue Code.
How do I request termination of individual coverage?
If you no longer wish to continue coverage please notify us in writing prior to the requested termination date. The termination request may be submitted via email to email@example.com or by fax to (614) 340-9444. You will receive confirmation that the termination was received and is being processed.
How do I request a change to my individual coverage?
Changes regarding a dependent require a change application to be completed with the updated information and must coincide with a qualifying event (if adding). A request to add a newborn as of their date of birth must be received within 30 days of the date of birth. A plan/deductible change may only be made during open enrollment. Please contact us at 1-800-282-1526 or by email at firstname.lastname@example.org for further assistance.
How are premium rates determined?
Premium rates both on and off of the marketplace are determined by the age of each individual who will be covered by a plan. Other factors that affect the premium for coverage include where a person lives and the level of plan (metal tier) that they select and whether they are a smoker or non-smoker.
Do I qualify for a healthcare subsidy?
Individuals may be eligible for government subsidies to help pay for premiums. Subsidies are available only for coverage purchased through the exchange. Subsidies are calculated based on the modified adjusted gross income for the year and the household size. Subsides may be available to individuals with incomes between 100% of the Federal Poverty Level (FPL) and 400% of the FPL. More information on qualifying for premium assistance can be found here.
Individuals may also qualify for savings on out-of-pocket costs when they obtain medical care. These savings are called "cost-sharing reductions." Cost-sharing reductions reduce the amount an individual pays for out-of-pocket costs such as deductibles, coinsurance and copayment.
Can I still buy individual insurance if I have a very serious pre-existing medical condition?
Under the ACA, insurers providing individual insurance will no longer be able to, in most cases, exclude, limit or deny coverage for any American including children under age 19 solely on the basis of a pre-existing condition.
What benefits will an individual health policy cover?
All individual health insurance plans will offer coverage that includes essential health benefits. The essential health benefits include:
- Ambulatory patient services
- Emergency services
- Maternity and newborn care
- Mental health and substance abuse disorder services
- Prescription drugs
- Laboratory services
- Preventive and wellness services
- Pediatric services
- Rehabilitative and habilitative services and devices.
Each plan or insurance company may add items or services to these minimum essential benefits and may vary the hospitals and doctors that are part of the network. It is important to compare plans and check to make sure the hospitals and providers you want are part of the plan’s network. Individual plans can be purchased through the exchange (healthcare.gov) or outside of the exchange (off-market plans) which are offered through an insurance agent.