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Special Enrollment

Outside open enrollment, you can enroll in new coverage or make changes to your existing policy only if you have a certain life event that qualifies you for a special enrollment period. This information applies to Individual/Family policies purchased directly from Dean Health Plan or through an insurance agent. If you receive your insurance through your employer, please contact your benefits administrator.

What is special enrollment?

Events that Qualify for Special Enrollment Periods
Unless indicated, these events qualify for a special enrollment period whether you purchase your insurance directly from us or through the Health Insurance Marketplace. You can make a change to your current plan and in some situations you can choose an entirely new plan.

Please contact us at (800) 279-1302 if you have further questions on what is a qualifying event.

Life Event

Marriage

Marriage

  • You can add your new spouse to your current plan or you can select a new family plan
  • Enrollment period: 60 days after wedding date
  • Effective coverage date: 1st day of the month following selection of coverage
  • Documentation required: marriage certificate

Birth/Adoption

Birth/Adoption

  • You can add your new child to your current plan or you can select a new family plan
  • Enrollment period: 60 days after birth/adoption date
  • Effective coverage date: date of birth or adoption
  • Documentation required: birth certificate, adoption paperwork or legal placement paperwork

Permanent Move

Permanent Move

  • Permanent move to an area not served by your current insurance carrier
  • You can select a new plan for yourself/family
  • Enrollment period: 60 days after date of move
  • Effective coverage date:
    • If coverage is selected between the 1st – 15th day of the month: Effective coverage date is the 1st day of the following month
    • If coverage is selected between the 16th – last day of the month: Effective coverage date is the first day of the second following month
  • Contact us to discuss your options regarding required documentation.

Change is made or new coverage selected between:

Effective date of coverage is:

1st – 15th of the month
Example: You make the change to your coverage on April 9

First day of the following month
Example: Your coverage will begin on May 1

16th – last day of the month
Example: You make the change to your coverage on April 19

First day of the second following month
Example: Your coverage will begin on June 1

What are my next steps?

 

Loss of coverage

Loss of employer-based insurance due to termination or reduction of hours

Loss of employer-based insurance due to termination or reduction of hours

  • You can select a new plan for yourself/family
  • Enrollment period: 60 days after the date of the event that triggers loss of coverage
  • Effective coverage date: 1st day of the month following selection of coverage
  • Contact us to discuss your options regarding required documentation

Loss of coverage due to divorce or death of a spouse

Loss of coverage due to divorce or death of a spouse

  • You can select a new plan for yourself/family
  • Enrollment period: 60 days after date of divorce/legal separation or death
  • Effective coverage date: 1st day of the month following selection of coverage
  • Contact us to discuss your options regarding required documentation

Loss of coverage on my parent’s plan when I turn 26

Loss of coverage on my parent’s plan when I turn 26

  • You can select a new plan for yourself
  • Enrollment period: 60 days after the date of the event
  • Effective coverage date: 1st day of the month following selection of coverage
  • Contact us to discuss your options regarding required documentation

 

Loss of coverage because my spouse qualifies for Medicare

Loss of coverage because my spouse qualifies for Medicare

  • You can select a new plan for yourself/family
  • Enrollment period: 60 days after date of Medicare eligibility
  • Effective coverage date: 1st day of the month following selection of coverage
  • Contact us to discuss your options regarding required documentation

What are my next steps?

 

Financial status change

Financial status change

Financial status change

Newly eligible or ineligible for Advanced Premium Tax Credits or Cost Sharing Reduction

  • You can select a new plan for yourself/family
  • Enrollment period: 60 days after the date of an eligibility change
  • Contact us to discuss your options regarding required documentation
  • Effective Coverage Date:
    • If coverage is selected between the 1st – 15th day of the month: Effective coverage date is the 1st day of the following month
    • If coverage is selected between the 16th – last day of the month: Effective coverage date is the first day of the second following month

Change is made or new coverage selected between:

Effective date of coverage is:

1st – 15th of the month
Example: You make the change to your coverage on April 9

First day of the following month
Example: Your coverage will begin on May 1

16th – last day of the month
Example: You make the change to your coverage on April 19

First day of the second following month
Example: Your coverage will begin on June 1

What are my next steps?

 

This website provides information on special enrollment periods only for members who have purchased an ACA–compliant individual plan and may not be applicable if you are remaining on you non-ACA compliant individual plan.  Additionally, this website may not include all special enrollment periods for which you may be eligible.  For more information please review your Individual Policy and Benefit Summary if you have individual coverage via DeanConnect at http://www.deancare.com/deanconnect/. If you purchased your health plan on the Health Insurance Marketplace, please note that you will be required to make any changes on healthcare.gov.