Know the options for health insurance outside of open enrollment


Today, TaxSlayer brings you a guest blog from our partners at VelaPoint Insurance.

The Affordable Care Act—a significant piece of legislation that changed the health insurance industry—established open enrollment periods. These periods, usually a three month window, are the only time during the year that most Americans can sign up for Qualified Health Plans, the kind of health insurance that qualifies for premium tax credits and cost-sharing reductions.

Enrollment periods, although they may seem inconvenient, help protect insurance companies from individuals who would otherwise only apply for coverage after they became sick or injured. Because, under the Affordable Care Act, applicants can’t be turned down for health insurance due to pre-existing conditions, insurance carriers can’t be selective about the kinds of risk they decided to insure against.

However, there are circumstances under which exceptions to the enrollment period are made. These situations are called Qualifying Life Events (QLEs). Some common examples of QLEs are:

  • Loss of essential health coverage: If you or one of your dependents loses health coverage that meets minimum government standards.
  • Change of family structure: If you gain a dependent or become a dependent because of a marriage, a death in the family or birth or adoption of a child.
  • Change in citizenship status: If you become a U.S. citizen, national or gain lawful status in the United States.
  • Experience government error: If you lose, change or enroll in coverage because of an error committed by an officer, employee or agent of the Exchange or the Department of Health and Human Services.
  • Change in subsidy eligibility: If you are determined newly eligible or newly ineligible for subsidies (advance payments of the premium tax credit or cost-sharing reductions).
  • Move to a new coverage area: If you permanently move to a new area and gain access to new Qualified Health Plans.

If you have a QLE, you can purchase a Qualified Health Plan or change an existing policy during a Special Enrollment Period that generally lasts between 30 and 60 days. The federal government and many insurance companies require specific proof of these events.

If you or your business clients are in need of insurance, connect with a licensed life and health expert who can determine eligibility for a SEP. Or, there are alternatives to major medical insurance such as a short-term medical policy.

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