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Enrollment
NJ Individual Health Coverage Program Buyer's Guide
There are limited times when you can enroll in an individual plan. 

 
Annual Open Enrollment Period

During the Annual Open Enrollment Period, people can buy individual insurance.  It does not matter whether you are buying your very first individual plan, or replacing individual coverage that you already have.  For 2017, the Annual Open Enrollment Period starts November 1, 2016 and continues through January 31, 2017. Coverage applied for between November 1 and December 31 of the Annual Open Enrollment Period will begin January 1 of the year following the Annual Open Enrollment Period.  When the Annual Open Enrollment Period extends beyond December 31 – as it will for 2017 – coverage applied for after December 31 will be effective on the first day of the month following the month the application is received (so, an application received January 10 will have a coverage effective date of February 1). Some carriers allow effective dates on the 15th of the month (in which case, an application received January 10 could have an effective date of January 15.) Applications must be received during the Annual Open Enrollment Period to be considered.

 
Special Enrollment Period

When certain events happen in your life, you have the right to buy an individual policy or change your current coverage without waiting for the Annual Open Enrollment Period.  These “triggering” events create 60-day Special Enrollment Periods.  The 60-day period starts on the date of the triggering event, although when the triggering event is an involuntary loss of coverage the special enrollment period begins 60 days prior to the loss of coverage and continues during the 60 days following the loss of coverage. This gives you the chance to buy a replacement plan that will begin on the day after your prior plan ends. 

Triggering Events

Generally, a triggering event is one that results in a change in your family, a change in your location, or one that results in a loss of minimum essential coverage for a family member.  It can also include a change in your eligibility for coverage.  It does NOT include a loss of coverage because you failed to pay premiums, or misrepresented material facts, or committed fraud.  If you lose coverage contact the carrier that issued the coverage you lost to ask if the loss of coverage is considered to be a triggering event. When there is a change in your family, such as birth or marriage, or if you move your primary residence, contact your current carrier and ask if the event entitles you to a special enrollment period.

Notice Required When Replacing Coverage
You cannot be covered under two individual plans.  If you are replacing an individual plan, be sure to notify the carrier of the plan being replaced that the individual policy should be terminated as of the day before the new policy takes effect.  Give notice no later than 30 days after the new policy takes effect.  So, if you are replacing coverage during an Annual Open Enrollment Period for a January 1 effective date, this means you should give notice no later than 30 days after January 1, that the old policy needs to be terminated as of December 31.

If you are buying an individual policy to replace group coverage, be sure to notify the group plan that you are waiving the group coverage.  You must waive group coverage as of the day before the new individual policy takes effect.  So, if you are buying an individual policy to replace group coverage during the individual Annual Open Enrollment Period for a January 1 effective date, you must waive the group coverage as of December 31.


Frequently Asked Questions About Enrollment
 
Question 1: If I decide not to buy coverage during the Annual Open Enrollment Period, can I buy coverage later?
  No, if you do not purchase or renew coverage during the Annual Open Enrollment Period, you will not be able to buy coverage in the individual market until the next Annual Open Enrollment Period, unless you have a triggering event that creates a Special Enrollment Period for you.
   
Question 2: Does the Annual Open Enrollment Period apply to NJFamilyCare?
  No. The Annual Open Enrollment Period applies to individual coverage offered by commercial health carriers. NJFamilyCare is a separate program, and someone who is possibly eligible for coverage through NJFamilyCare may apply to that program at any time.
   
Question 3: If I lose employer coverage, but can make a COBRA election, can I still buy an individual plan?  What about a New Jersey Small Group continuation election, or a Dependent Under 31 election?
  Yes, you can choose to buy an individual plan during the Special Enrollment Period triggered by the loss of the employer's coverage, or make the continuation election. Please carefully review the continuation options available to you in terms of benefits and costs and compare them to individual coverage options; then select the option that best suits your needs.
   
Question 4:  If I buy a plan, and a few months later, decide I want to change it, how soon can I make that change?
 

You can make changes only during the Annual Open Enrollment Period OR during a Special Enrollment Period.  A Special Enrollment Period only occurs if there is a triggering event.  Wanting to change a plan is not a triggering event.  But if a triggering event is part of the reason you want to change your plan, then you have a Special Enrollment Period, and you can change the plan during the Special Enrollment Period.  For example, if you get married, you can change from covering just yourself to covering yourself and your spouse during the Special Enrollment Period, rather than waiting for the Annual Open Enrollment Period.

   
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