Under the Affordable Care Act (ACA), special enrollment periods (SEPs) are established to address circumstances when, due to a qualifying event, individuals can purchase coverage outside the open enrollment periods. After the close of the annual open enrollment period, individuals are only able to enroll in a health plan during an SEP triggered by a qualifying event. In the ACA’s first years, the Center for Consumer Information and Insurance Oversight (CCIIO) regulations recognized a broad range of qualifying events that could trigger an SEP, allowing qualified individuals to sign up for health insurance coverage on an exchange outside the annual open enrollment period. In guidance issued on Jan. 19, 2016, the Department of Health and Human Services appears to be responding to concerns about adverse selection by tightening SEP exceptions. The guidance eliminates seven qualifying events for the open enrollment period that began on Nov. 1, 2015, and ended Jan. 31, 2016.
Deborah Dorman-Rodriguez, Leader of the Healthcare Practice Group, and David M. Kaufman, Partner in the Healthcare Practice Group, recently co-authored a client alert about the elimination of these seven qualifying events. The article is titled "CCIIO Eliminates Qualifying Events."
