Market reforms have consequences! Everyone is aware that insurance carriers can no longer impose pre-existing condition exclusions on policies. What is not as well understood is how this affects when members can enroll on individual and group policies. Here is a quick guide to enrollment periods in the IHC & SEH Markets.

Small Group Coverage
Upon their 2014 renewal, small employer groups and their employees no longer enjoy continuous enrollment. This means that an employee must enroll upon initial eligibility, during an open enrollment period or during a special enrollment period. If an employee is outside one of these windows, he or she cannot enroll on the group health plan.

- Employee Open Enrollment Periods. This is a 30 day period prior to the group's anniversary where employees can enroll for the first time or switch plans (if multiple sub-groups are available).

- Special Open Enrollment Periods. These are periods based on triggering events specific to an individual employee.

- A comprehensive list of triggering events is included in the new SEH regulations below.

- Proof of a triggering event is always encouraged and sometimes required.

Individual Coverage
Enrollment in an individual policy will also be limited to an open enrollment or special enrollment period. If an individual is outside of an open enrollment period and does not have a triggering event, he or she cannot enroll in individual coverage.

- The Initial Open Enrollment Period to purchase individual coverage ends March 31st, 2014.

- Special Open Enrollment Periods. These are periods based on triggering events specific to the individual.

- A comprehensive list is included in the new IHC Buyers Guide linked below.

- Proof of a triggering event is always encouraged and sometimes required.