Qualifying Events

Open Enrollment Guidelines of the ACA Healthcare Reform

ACA Healthcare Reform laws require all individuals have health insurance, or face a potential penalty.  Accordingly, this mandatee can be satisfied either through an individual policy or throughan employer paid policy.  However, individuals can only purchase policies during the annual open enrollment of November 1st through December 15th of each year.

Did you miss the deadline?  You can still enroll if you meet any of the following qualifying events:

  • change in legal marital status
  • a change in the number of dependants
  • a change in place of residence and the current carrier is not available
  • significant cost or coverage change
  • a change in coverage of a spouse or dependant
  • a COBRA qualifying event
  • legal judgements, decrees and orders
  • entitlement to Medicare or Medicaid

** The individual penalty has been repealed for 2019 and beyond. **

The ACA Essential Benefits

What your policy must cover, as mandated by the ACA Healthcare Reform

To be in compliance with ACA healthcare reform laws and avoid costly penalties, you must purchase insurance coverage that pays at least 60% of the costs of the following “essential benefits.”

  • Ambulatory patient services
  • Emergency services
  • Hospitalization
  • Maternity and newborn care
  • Prescription Drugs
  • Mental health and Substance Abuse disorder services
  • Rehabilitative and habilitative services and devices
  • Pediatric services, including oral and vision care
  • Preventive and wellness services, and chronic disease management