When it comes to enrolling in health insurance, the rules and regulations can be confusing. During open enrollment, the government and some states offer private health insurance plans that can be enrolled in before December 15th. Many employers also offer health insurance plans to new employees on their first day, but employers are free to decide when health benefits for new employees come into effect. The Affordable Care Act (ACA) dictates that employers should not wait more than 90 days before offering health insurance.
This includes weekends and holidays. The effective date of your coverage depends on the date you enroll, but there are some variations from state to state. If you enroll in the marketplaces, your coverage won't take effect right away. Generally, if you enroll before December 15th, your coverage will take effect on January 1st.
If you enroll between January 16th and January 15th, your coverage will take effect on February 1st. In addition, if any insurer leaves the market or cancels certain plans at the end of the year, people enrolled in those plans will be eligible for special enrollment periods. The special enrollment period will last 60 days before and 60 days after the loss of coverage. If your old plan ends in the middle of the month, you may consider a short-term health insurance plan for this period or COBRA retroactively if a medical need arises before the new plan takes effect.
Outside of open enrollment, the effective dates generally follow the same rules as inside open enrollment. However, some insurers in some states choose to extend the enrollment deadline to December 31st to obtain coverage starting January 1st if they apply outside of the exchange market during open enrollment. If you enroll in a plan that doesn't comply with the ACA (such as a short-term health plan), coverage may take effect the day after you enroll, but the insurer can use your medical subscription to determine your eligibility for coverage. Most employers have plan years that are synchronized with the calendar year, but some don't.
Therefore, your wife's employer may have an annual plan that runs from December to November instead of following the calendar year. Sometimes employers offer additional insurance benefits such as vision plans, dental plans, and workplace wellness programs but these are not required by law. Sign up for email (or text) updates with important deadline reminders, helpful tips, and other information about your health insurance. With an HMO, you're generally not allowed to go directly to any health care provider you choose and if you do go outside of their approved network you will usually have to pay out-of-pocket costs.
Because of the employer's mandate under the ACA, employers with 50 or more full-time employees or full-time equivalent (FTE) employees must provide health insurance to at least 95% of people who work full time. Taking the time to understand when your health insurance comes into effect at a new job can help eliminate some of the stress associated with such an important life event. Finally, learn about Medicaid, sick days, reimbursement schedules and availability of life insurance to learn how these factors could affect your health care coverage. An EPO is a group health insurance option that can offer greater flexibility and potentially expedited care.
