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Employer News | September 2016
Employer News | September 2016

Special Enrollment Period Coverage Effective Dates and Deadlines

Individuals with direct purchase policies from Excellus BlueCross BlueShield (“off exchange”) coverage with a Special Enrollment Period

Certain life changes may qualify for the opportunity to enroll in health care coverage for the remainder of 2016 outside of the annual Open Enrollment period.

Examples of qualifying events are:

  • Pregnancy
  • Having a baby
  • Getting married

or

  • Losing health coverage


Effective dates will be determined by:

  • The type of qualifying event
  • The timing of the event
  • Effective date requested (if applicable).

The majority of events will follow a 15th of the month rule.

  • For applications received on or before the 15th of the month, coverage will be effective the 1st of the following month. (For example, an application received on August 15 would be effective September 1.)
  • For applications received after the 15th of the month, coverage will be effective the 1st of the second following month. (An application received on August 16 would be effective October 1.)

If notification about a qualifying event is received after 60 days from the date of the event, enrollment is not allowed until the next Open Enrollment Period (except in cases of pregnancy, birth, newborn adoption, domestic abuse or spousal abandonment, which allow for mid-month effective dates and do not follow the 15th of the month rule).


Individuals with New York State of Health Marketplace exchange coverage with a Special Enrollment Period

Visit info.nystateofhealth.ny.gov/SpecialEnrollmentPeriods for more information.

Group coverage termination

If group coverage is being terminated, members have the right to convert to a direct payment health insurance plan.

To convert coverage, an application must be submitted along with full payment of the first premium amount within 60 days after coverage terminates.

After 60 days, enrollment may not be allowed until the next Open Enrollment Period.

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