New children can help their family members break out of the usual open enrollment period coverage purchase restrictions and buy coverage now, when the exchanges are shutting out most ordinary consumers, officials say.
See also: Health market gets special
CMS — an arm of the U.S. Department of Health and Human Services (HHS) — developed the fact sheet for the assisters who help consumers use the Patient Protection and Affordable Care Act (PPACA) exchanges that are run by HHS.
PPACA now forbids issuers of individual major medical insurance from considering personal health information when deciding whether to sell insurance, and it forbids insurers from considering health information other than age and tobacco use when pricing the coverage.
To discourage people from waiting until they get sick to buy 2014 coverage, the HHS-run exchanges required most individual health insurance users to buy their qualified health plan (QHP) coverage during an open enrollment period that started Oct. 1, 2013, and petered out in mid-April.
The open enrollment period for 2015 coverage is not set to start until Nov. 15, 2014. To buy individual coverage today, consumers must qualify for a “special enrollment period” (SEP).
A consumer can qualify for a 60-day SEP by providing evidence of a major life change, such as a move to a new market, a marriage — or “birth, adopting or fostering a child.”
In the HHS-run exchanges, “this qualifying event applies to all family members on the application, not just the new child,” CMS officials say in the fact sheet.
Adding a child to a family “will allow qualified individuals to enroll in a QHP even if they previously were not enrolled,” officials say. “It also allows consumers who are currently enrolled in a QHP to select a different QHP.”