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Recently Had A Life Changing Event?

If you experience a major life change, it could affect your health insurance coverage. 

•    If you are uninsured, you may be able to get insurance
•    If you have coverage, you may be able to change plans
•    If you have coverage through NY State of Health or have a problem with that coverage, your insurance may be affected differently

Some life changes trigger what is called a “special enrollment” period.  Special enrollment lets you get or change your private coverage outside of open enrollment.  Special enrollment periods can be as short as 30 days, so you should act fast.  The New York State of Health (NYSOH) has issued Frequently Asked Questions (FAQS) on Special Enrollment Periods (PDF) for consumers to understand their options and how to action in order to avoid penalties.

It's important to know that you may not want to change plans even if you can.  If you change plans mid-year, you must meet the new plan's deductible and cost-sharing.  Any money you spent on care while enrolled in the old plan will not count towards the new plan's deductible, copays, coinsurance or out-of-pocket maximum.

Whether you have health insurance or don't, these events let you and/or your family members newly enroll in health insurance OR change to a different health plan:
  • You gain a dependent or become a dependent through marriage, birth, adoption, placement for adoption, or placement in foster care
  • You move to New York from another state or you move to a new county within New York
  • You are losing minimum essential coverage due to:
    • Reduction in hours at a job
    • Loss of job
    • Divorce
    • Death of a spouse
    • Attainment of age (young adults maintaining coverage through age 26 law)

If you get coverage through the NY State of Health and you experience a life changing event, even just a salary change, you must let the marketplace know.
  • Making sure the NY State of Health has current information about you is required.
    • Maintaining up to date information can also make renewing your coverage easier. 
    • Update your information online or by calling 1-855-355-5777.
  • Changes to your family size or income could also make you newly eligible for Premium Tax Credits or change the amount you can get. You may even become newly eligible for public health insurance. 
  • There are also certain events that let you and your family members have a special enrollment period only in the NY State of Health, such as:
    • You are determined newly eligible or newly ineligible for premium tax credits or cost-sharing reductions.
    • Your immigration status changes – for example, you were not previously a citizen, national, or lawfully present individual you gain one of these statuses.
    • You are an American Indian or Alaskan Native.  You may enroll in a health plan or change from one plan to another one time per month.
    • You demonstrate to NYSOH, in accordance with guidelines issued by HHS, that you meet other exceptional circumstances that warrant allowing you to change plans.
    • You adequately demonstrate to NYSOH that your health plan substantially violated a material provision of its contract.
    • Your enrollment or non-enrollment in a health plan is the result of the error, misrepresentation, or inaction of an officer, employee, or agent of NYSOH or the federal Department of Health.
    • The NYSOH determines that you were not enrolled in a health plan that you are eligible for or not receiving premium tax credits or cost-sharing reductions as a result of misconduct on the part of a non-marketplace entity providing enrollment assistance or conducting enrollment activities.

Take Action if you have coverage through the NY State of Health individuals & familes marketplace, or through an insurer in the individual market outside of the marketplace, you only have sixty days (60) after a life changing event to make changes to your insurance or enroll in a health plan.  To avoid a gap in coverage, if you are losing health insurance, you can apply for a new plan as early as 60 days before your current insurance will end.

If you are enrolled in health insurance through a job (group coverage), you may only have thirty days (30) after the event to make changes to your coverage.

In some cases when a life changing event makes you lose coverage, you may be able to claim an exemption to avoid paying a penalty for the time you are uninsured.

Remember, during Open Enrollment, everyone can enroll in health insurance or change their health plan.


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