Your HR & People Operations Questions, AnsweredI missed open enrollment for my insurance and now I need to appeal the decision. What do I do? Write a good letter?
HR Questions>I missed open enrollment for my insurance and now I need to appeal the decision. What do I do? Write a good letter?

I missed open enrollment for my insurance and now I need to appeal the decision. What do I do? Write a good letter?

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Mario asked 6 months ago

1 Answer
Riia O’Donnell replied 6 months ago
Mario,

The answer to your question may depend on whose open enrollment you missed and why.

If you missed open enrollment through your employer, you’ve probably already asked for their help but there may be nothing they can do. Depending on who the healthcare plan provider is, there may be contractual agreements that do not allow for enrollment outside the open enrollment period except under very specific circumstances.

Some providers will allow workers to submit an appeal, asking for another chance to participate in the plan, others will not. If the health plan provider allows, you may submit a letter outlining why you missed the enrollment and asking they let you sign up. It will be at their discretion whether or not to agree. If you do write a letter, you’ll want to include a very good reason why you missed the deadline – not just that you forgot.

Under certain circumstances, employers can let workers join or change their plan options under a Special Enrollment Period. These SEPs are allowable only if the employee has had a qualifying event. These include:

• Loss of existing health coverage from another (or spouse’s) employer, through a parent’s plan, aging out of parental or student plans, or lost eligibility for Medicare/Medicaid/CHIP

• Marriage, divorce, birth or placement of a child in the household

Most private (employer-sponsored) healthcare providers allow for special enrollment changes within 30 days of the qualifying event. If no qualifying event occurred, and the private healthcare plan provider does not allow or agree to your appeal, you’ll have to wait until the next open enrollment or qualifying event to join the plan.

If you choose coverage through the Affordable Care Act Exchanges, you may reinstate coverage for any of the qualifying events listed above and some additional qualifying events for eligibility. These include:

• Changes in residence, including moving to another service plan area
• Death in the household
• Changes to household income
• Becoming a US citizen
• Hospitalization for a prolonged illness
• If you suffered a temporary cognitive disability
• If you were released from a detention facility or prison
• You were the victim of a natural disaster
• There was an error made by an insurer, agent or government entity during enrollment

Under the ACA, Special Enrollment Periods begin the first day of your qualifying event and last for 60 days afterward. If you missed those time periods, you will need to wait for the next open enrollment at the end of the year.

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