I administer a self-funded health plan for an employer with over 40,000 employees.

  1. 15645 POINTS
    Edward HarrisPRO
    Owner, Best Health And Car Insurance Rates - Instant Online Quotes, US
    The Affordable Care Act (ACA) legislation allows you to purchase/enroll health insurance coverage at any time during the year (including outside of Open Enrollment) if you have a "qualifying life event." A "Special Enrollment Period" (SEP) is thus created and a you also become eligible for federal subsidies that can substantially lower your premium. This "loss of essential coverage" also allows you to choose among all available Marketplace plans.

    You have 60 days from the date of the event to choose and apply for coverage. Some of the most common SEP situations are divorce, having a baby (the newborn is eligible), losing employer-provided coverage, reaching age 26 while on parent's plan, becoming a US citizen, and moving to a different service area.

    Important: Answer was provided by Edward Harris, one of the leading US health insurance brokers with more than 35 years of experience. His award-winning website, majormedicalhealth.com, provides free online quotes to consumers, accompanied by the lowest available rates provided by major US healthcare companies.
    Answered on June 29, 2015
  2. 21750 POINTS
    Jim Winkler
    CEO/Owner, Winkler Financial Group, Houston, Texas
    That is a great question! Are you asking in regards to whether they are become at risk for losing the tax exemption during that period or afterwards? My understanding is that during that 60 day window the newly uninsured does not incur that risk. They are still considered insured for the duration of the window. As long as the person re-enrolls in an approved plan, or opts for COBRA extension of coverage, they will not incur penalties. I'd imagine that there would have to be a significant amount of time passed as uninsured to become at risk for incurring the tax penalties. Good question, thanks for asking it!
    Answered on July 18, 2015
  3. 836 POINTS
    Kyla Beamon
    Insurance Concierge, M&G Insurance, Lake Oswego Oregon
    A quick add on to the above: Having a baby or adopting is a Qualifying Event for the whole family. So if for some reason the mother was on a health insurance plan, but the husband was not he would now be part of the Qualifying Event and be able to choose a plan during the 60 day window.
    Answered on August 19, 2015
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