INDIVIDUAL INSURANCE FAQ’s
Is a qualifying event required to enroll on an individual plan outside of open enrollment? Yes, individuals cannot enroll outside of open enrollment without a qualifying event. Proof of the qualifying event is required with the application; the applicant cannot be enrolled without this.
How do I know if my client has a qualifying event? Here are some common examples of qualifying events. This is not an all-inclusive list so please refer to healthcare.gov for more information.
- Having a baby
- Losing job-based coverage for any reason, including resigning, getting laid off, or getting fired
- Expiration of COBRA coverage
- Losing coverage under your parents’ plan at age 26
- Getting divorced or legally separated (resulting in loss of coverage)
- Losing eligibility for Medicaid or the Children’s Health Insurance Program (CHIP)
- Permanently moving outside your plan’s coverage area
How long does my client have to apply after their qualifying event? Typically, up to 60 days after the event. If the client does not apply within the 60-day time frame they may have to wait until the next open enrollment period to get coverage.
How is an on-exchange individual policy canceled? On-exchange policies must be canceled directly with healthcare.gov, either over the phone or online. Off-exchange policies are canceled directly with the carrier.
Do I have to be certified to sell on-exchange plans? Yes! In order to sell on-exchange plans, brokers must certify annually via CMS. If you are not certified you cannot sell or receive a commission for on-exchange plans. You must re-certify each year.