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Enrollment
NJ Individual Health Coverage Program Buyer's Guide

There are limited times when you can enroll in an individual plan.  The rules are a little different in 2014 and years after 2014.  The extra enrollment periods for 2014 are described first.

 
Extra Enrollment Periods for 2014

There is an INITIAL ENROLLMENT PERIOD for 2014 that runs from October 1, 2013 through March 31, 2014.  Applications must be received during the Initial Enrollment Period to be considered.  Coverage applied for during the Initial Enrollment Period can begin as early as January 1, 2014, but only if your application is received by the carrier no later than December 31, 2013.  After December 31, 2013, the effective date of coverage will be the 1st of the month following the date the application is received (for example, an application received January 10 will have a coverage effective date of February 1).  Some carriers may also allow effective dates on the 15th of the month (in which case, an application received January 10 could have a coverage effective date of January 15).

There is a LIMITED ENROLLMENT PERIOD for 2014 that applies only to people who already had individual coverage as of January 1, 2014.  A person who had coverage prior to January 1, 2014 can keep the plan until the plan’s anniversary date in 2014.  In order to help such people replace the old plan with a new plan without any break in coverage, they are given a 30-day period prior to their old plan’s anniversary date to enroll in a replacement plan.  So, someone whose old plan has an anniversary date of June 1 can decide if they want to replace that plan during the Initial Enrollment Period or wait to replace the plan on June 1 by submitting an application during his or her personal Limited Enrollment Period in May.  Applications must be received during the limited enrollment period.

 
Annual Open Enrollment Period

Beginning in 2014, and for each year after that, there will be an Annual Open Enrollment Period from October 15 through December 7.  During the Annual Open Enrollment Period, people can buy individual insurance.  It does not matter whether you are buying your very first individual plan, or replacing individual coverage that you already have.  Coverage applied for during the Annual Open Enrollment Period will begin January 1 of the year following the Annual Open Enrollment Period.  Applications must be received during the Annual Open Enrollment Period to be considered.

 
Special Enrollment Period

When certain events happen in your life, you have the right to buy an individual policy or change your current coverage without waiting for the Annual Open Enrollment Period.  These “triggering” events create 60-day Special Enrollment Periods.  The 60-day period starts on the date of the triggering event. 

Triggering Events

Generally, a triggering event is one that results in a change in your family, a change in your location, or one that results in a loss of minimum essential coverage for a family member.  It can also include a change in your eligibility for coverage.  It does NOT include a loss of coverage because you failed to pay premiums, or misrepresented material facts, or committed fraud.  If you lose coverage contact the carrier that issued the coverage you lost to ask if the loss of coverage is considered to be a triggering event. When there is a change in your family, such as birth or marriage, or if you move your primary residence, contact your currrent carrier and ask if the event entitles you to a special enrollment period.

Notice Required When Replacing Coverage
You cannot be covered under two individual plans.  If you are replacing an individual plan, be sure to notify the carrier of the plan being replaced that the individual policy should be terminated as of the day before the new policy takes effect.  Give notice no later than 30 days after the new policy takes effect.  So, if you are replacing coverage during an Annual Open Enrollment Period, this means you should give notice to no later than 30 days after January 1, that the old policy needs to be terminated as of December 31.

If you are buying an individual policy to replace group coverage, be sure to notify the group plan that you are waiving the group coverage.  You must waive group coverage as of the day before the new individual policy takes effect.  So, if you are buying an individual policy to replace group coverage during the individual Annual Open Enrollment Period, you must waive the group coverage as of December 31.


Frequently Asked Questions About Enrollment
 
Question 1: Do I have to give up my existing plan? Why? When?
  No plans that were offered in the individual market under the New Jersey Individual Health Coverage Program prior to 2014 can be renewed in 2014.  The old plan designs do not meet all of the federal requirements for plans to be sold or renewed in 2014.  You may keep any plan you purchased prior to 2014 until its anniversary date in 2014.  In order to avoid having a break in coverage you can buy a new plan during the Initial Enrollment Period, or you can wait to replace it during the 2014-only Limited Enrollment Period that starts 30-days prior to your plan’s anniversary date.
   
Question 2: Can you explain the open enrollment periods in 2014?
  People can start enrolling in plans that will be issued in 2014 as early as October in 2013.  This Initial Enrollment Period will continue through March 31, 2013.  After that, you can only enroll for coverage to be effective in 2014 if you are eligible for a Limited Enrollment Period or a Special Enrollment Period.  You are eligible for a Limited Enrollment Period if you have current individual insurance.  You are eligible for a Special Enrollment Period if you have a triggering event. 
    
On October 15, 2014, the Annual Open Enrollment Period will start and continue through December 7, 2014.  BUT when someone submits an application for coverage during the Annual Open Enrollment Period in 2014, he or she will be applying for coverage that will become effective on January 1, 2015, NOT for coverage to be effective in 2014.
   
Question 3: If I lose employer coverage, but can make a COBRA election, can I still buy an individual plan?  What about a New Jersey Small Group continuation election, or a Dependent Under 31 election?
  Yes. Please carefully review the continuation options available to you in terms of benefits and costs and compare them to individual coverage options; then select the option that best suits your needs.
   
Question 4:  If I buy a plan, and a few months later, decide I want to change it, how soon can I make that change?
 

You can make changes only during the Annual Open Enrollment Period OR during a Special Enrollment Period.  A Special Enrollment Period only occurs if there is a triggering event.  Wanting to change a plan is not a triggering event.  But if a triggering event is part of the reason you want to change your plan, then you have a Special Enrollment Period, and you can change the plan during the Special Enrollment Period.  For example, if you get married, you can change from covering just yourself to covering yourself and your spouse during the Special Enrollment Period, rather than waiting for the Annual Open Enrollment Period.

   
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