Special enrollment

Qualifying Event

A qualifying event is a change in life that makes an individual or a family eligible to enroll in or make a change to health coverage outside of the regular open enrollment period.

Enrollment Period

The amount of time you have to enroll in or make a change to your coverage after the qualifying event takes place. Most qualifying events have a 60-day enrollment period.

Effective Coverage Date

The date insurance coverage begins. This date depends on the qualifying event. For example, coverage for a new spouse begins the first day of the month after the change.

Qualifying events

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.

icon of wedding rings  Life events

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

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 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
  • Documentation required: Contact us to discuss your options regarding required documentation.

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
  • 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
  • Documentation required: Contact us to discuss your options regarding required documentation

If you are turning 65, this starts the initial enrollment period for Medicare, which is the seven-month period during which you can enroll in Medicare for the first time. If you miss enrolling for Medicare during your Initial Enrollment Period, you will not be able to enroll until the following Annual Enrolment Period, which occurs from October 1 to December 7 each year. 

  • Enrollment period: 3 months before your 65th birthday, the month of your birthday and the 3 months after your birthday.
  • Effective coverage date: 1st day of the month following selection of coverage.
  • Documentation required: Contact us to discuss your options regarding required documentation.

Learn more about Medicare

icon of an elderly woman  Loss of coverage

You can select a new plan for yourself/family

  • Enrollment timeframe: Application must be made within 60 days prior to or after the event date
  • Effective date of coverage: If application is received prior to the event date the effective date will be the first of the month following the event date. If application is received after the event date the effective date will be the first of the month following application receipt date.
  • Documentation required: Contact us to discuss your options regarding required documentation

Example: Loss of coverage event date is 11/30. For an application received on 10/31, the new coverage effective date will be 12/1. For an application received on 12/15, the new coverage effective date will be 1/1.

You can select a new plan for yourself/family.

  • Enrollment timeframe: Application must be made within 60 days prior to or after the event date
  • Effective date of coverage: If application is received prior to the event date the effective date will be the first of the month following the event date. If application is received after the event date the effective date will be the first of the month following application receipt date.
  • Documentation required: Contact us to discuss your options regarding required documentation

Example: Loss of coverage event date is 11/30. For an application received on 10/31, the new coverage effective date will be 12/1. For an application received on 12/15, the new coverage effective date will be 1/1.

You can select a new plan for yourself if you have recently turned 26 and are no longer covered on your parent's insurance plan.

  • Enrollment timeframe: Application must be made within 60 days prior to or after the event date
  • Effective date of coverage: If application is received prior to the event date the effective date will be the first of the month following the event date. If application is received after the event date the effective date will be the first of the month following application receipt date.
  • Documentation required: Contact us to discuss your options regarding required documentation

Example: Loss of coverage event date is 11/30. For an application received on 10/31, the new coverage effective date will be 12/1. For an application received on 12/15, the new coverage effective date will be 1/1.

You can select a new plan for yourself/family.

  • Enrollment timeframe: Application must be made within 60 days prior to or after the event date
  • Effective date of coverage: If application is received prior to the event date the effective date will be the first of the month following the event date. If application is received after the event date the effective date will be the first of the month following application receipt date.
  • Documentation required: Contact us to discuss your options regarding required documentation

Example: Loss of coverage event date is 11/30. For an application received on 10/31, the new coverage effective date will be 12/1. For an application received on 12/15, the new coverage effective date will be 1/1.

What are my next steps?

The process to make changes to your plan depends on where you purchase your health insurance.

  • If you are eligible for financial assistance and/or you currently have a plan through the Health Insurance Marketplace (Exchange), make changes at healthcare.gov.
  • If you want to purchase a new plan—including subsidy-eligible Marketplace plans — see available plans.
  • If you are unsure where you purchased your plan and/or want to make a change to your existing WellFirst Health policy, call us at 866-514-4194 (TTY: 711).
Find a plan today

 

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 your 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 the portal. 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.

SSM Health Plan is an HMO/HMO-POS with a Medicare contract. Enrollment in SSM Health Plan depends on contract renewal. SSM Health Plan markets under the name WellFirst Health — Provided by SSM Health Plan. This information is not a complete description of benefits. Call 833-551-0565 (TTY: 711) for more information. You must continue to pay your Medicare Part B premium.

H8019_wellfirstbenefits.com
Updated 1/22/21