Open Enrollment in Health Insurance: Explained

When Is Open Enrollment for Health Insurance?

Health Insurance is hared to remember about sometimes and usually once you think about it, its too late to fin a good affordable one. Open,  enrolment may be defined as the period during which all the employees of various organizations, be it government or private, can alter their already existing medical insurance plans.


How Often Does Annual Enrolment Occur for Health Insurance?

Open enrolment doesn’t need to occur yearly. Various exchanges are established by the government where customers can buy insurance products. Open enrolment also includes the period during which people can avail of medical insurance via these online medical exchanges. New members are also allowed to enroll at any time throughout the year, as long as they qualify for a special event.


Can The Individual Change Their Original Medical Insurance?

During this open enrolment program, by the government, one can also choose to modify the plans within national medical insurance provided by the state and central governments. They can choose to alter the medical plans or stick to the original insurance plans as chalked out by the state government.


How Can Information Regarding Open Enrolment Be Promulgated?

Once the open enrolment for medical insurance is open, it gives a fair chance to all the employers and medical insurance companies. They can elaborate all their products to the individuals. The vendors are directly available to explain all these insurance products. These can be in the form of (a) fairs, (b) presentations, and (c) one-to-one meetings. Sometimes when travelling to a certain location becomes cumbersome or extra expensive, these vendors try to cut down expenses. They can do the same by employing contract enrollers who can communicate all the plan’s benefits to the individual.

Once the decision regarding medical insurance is taken in due course, all the plans and benefits come into effect from the next year. Therefore, open season is an important aspect of the medical insurance program where all the active employees and retired employees can choose from a host of plans made for them and their families.


Can A Person Register or Alter Medical Plan Outside The Enrolment Period? 

The original period for the open enrolment was earlier stipulated at three months. The time ranges from November to January. After a while, the period for open enrolment was reduced from three months to forty-five days. The period ranges from November to Mid-January. If there is an event of medical insurance that qualifies as being eligible for enrolling outside period, it can be considered. The following events can be considered as the qualifying events-

  • One loses one’s job and eventually loses all the health insurance benefits are attached to the same.
  • Changes in the household including marriage, divorce, birth or adoption of a baby, etc.
  • Death of spouse that results in loss of the coverage.
  • Changes in the residential address of the individual.
  • A decrease in working hours that render an individual ineligible for any insurance benefits
  • A person already covered by any health maintenance organization moves outside the area covered by it.

Other than this, medical insurance cannot be availed outside the enrolment period. This special enrolment period is eligible for sixty days. If one wishes, they can enroll themselves within this period. If unable to do so, they get themselves enrolled only during the next year’s open enrollment period.


What Happens If One Misses the Open Enrolment Period And Does Not Qualify For Special Enrolment?

There might be cases where due to some reason, an individual might have missed the open enrolment period for availing the health insurance and does not qualify to register himself under special enrolment. In all these cases, he can register himself for short-term insurance plans. These short-term plans can be availed beyond the open enrolment period for a period extending up to 364 days. These short-term plans work best for generally fit people and do not have any pre-existing health conditions. This is because these short-term plans do not cover the pre-existing conditions.

This special enrolment period during 2021 has been extended up to August.

If a person does not wish to avail of these short-term plans, they can then wait for a whole another year before the next open enrolment starts. People can check out the various medical plans online and compare them before they can arrive at an informed decision to choose their medical plans.


Essential Benefits Provided By Medical Insurance

All the plans covered under medical insurance have to cover a few benefits that need to be provided to the plan holder. These benefits are as follows:

  1. Care for outpatient which includes management of chronic diseases
  2. Hospitalization
  3. Emergency services
  4. Newborn care and Pregnancy
  5. Substance abuse and medical care
  6. Laboratory tests
  7. Vision and dental care for children
  8. Drugs based on prescription
  9. Wellness care and preventive care

All the different plans have a different scope of coverage for all these plans. Hence all the details of coverage, deductibles, and premiums must be provided to the prospective customer before selling the plan. These details must be available and visible on the websites of these insurance companies so that it gives the customer some ease in choosing what is best.


What Are the Tax Benefits Attached?

A tax credit can be availed by the individual based on certain limits of income as set by the government. If an individual’s income falls between those limits, they can apply for these tax credits applicable to the premiums that one pays monthly. However, if an individual’s income changes and breaches the maximum upper limit as set by the government, all the tax credit will be reversed. This means that even if tax credit has been done to the individual, it will again be deducted based on ineligibility due to increased income. All these limits and laws apply to the available plans during the open enrolment that will be done during 2021.

Hence, we can conclude that there are several ways to buy the best medical insurance plan for an individual during the open enrolment period. This includes buying directly, websites, insurance agents, and market places set up by state and central governments. Thus, unless something unusual happens that qualifies as special, one can easily purchase health insurance with all its benefits and ensure their own and their families lives.