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December 2018 E-News from Texas Insurance & Financial Services



What to do if you do not have ACA Open Enrollment

Although the Act of Tax Cuts and Jobs effectively abolishes the tax penalty for not having health insurance, individual plans are still an important protection against unexpected medical bills. In addition, they also cover many preventive procedures, such as annual health visits and vaccinations.

However, the open enrollment period, the time insurance companies must accept you regardless of existing conditions, was shorter this year than previous years, running from November 1

to December 15. If you miss your registration deadline, you may still have options.

Special Registration Periods
First, you can qualify for a Special Registration Period (SEP). This may apply if you are going through a qualified life event. If you qualify for an SEP, you have up to 60 days after the date of the event to register with an individual health insurance plan under the Affordable Care Act. Examples of qualified life events include:

  • Marriage, divorce, birth of a child, death in the family or adoption
  • Change of residence
  • Loss of health coverage (ie dismissal from employment)


You can also qualify to a 60-day SEP if one or more of these qualifying conditions apply:

  • You become a US citizen
  • You are released from prison
  • You lose the right to Medicaid or Children & # 39 ;s Health Insurance Program [19659009] Group Plans
    If you do not qualify for an SEP, you may be able to get ACA-qualified health insurance by being employed by a company that sponsors a group health plan. [19659003] Generally, you can sign up for your employer plan during an initial enrollment period, which can occur at any time of the year. As long as you take the chance to register when you are first eligible, during the first open enrollment period set by your employer, you do not have to wait until the annual period.

    Short-term health plans [19659005] In a pinch, you may be able to qualify for a short-term medical (STM) insurance. These will provide very basic insurance coverage for a limited period of time, which varies by state. Federal regulations now allow for up to 364 days and up to three renewals, but many states adopt much more restrictive guidelines.

    STM plans generally cover emergency visits, hospital stays, laboratory and X-ray fees, and outpatient surgeries. They exclude preventive services and prescription drugs, except during hospital stays.

    STM plans are not ACA compliant. They provide less coverage and often exclude existing conditions. There is no guaranteed problem determination, which means that carriers can reject you based on your medical history.

    Although these plans do not replace ACA compliant insurance, they may be appropriate when you are between jobs or waiting for a qualified life event or open enrollment period to come.

    Critical Health Insurance
    You may also be able to get critical illness coverage. This will pay a cash benefit if you are diagnosed with a condition covered by the policy, such as cancer. Although you can expect a medical record check and possibly a medical examination, there is no open registration period for these plans, and you can register with them at any time during the year.

    If you do not have an open registration period this year, do not & # 39; t give up! You should still protect yourself from unexpected medical costs as best you can. Call us today and let us help you explore your options.


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