Drop Dead Deadline

It is common for the Human Resources person at a workplace to pass out new forms every year during open enrollment, requiring every employee to indicate their personal information and that of their spouse and children, as well as the health plan they are choosing, the primary care physician, etc. It seems that there is always a question that cannot be answered immediately so these forms are set aside to complete later. Sometimes, later is after the deadline that the Human Resources person set. In many cases, the insurance companies are flexible and coverage can still be applied. However, that is not necessarily the case anymore!

For health insurance policies effective on January 1st purchased through the New York State Health Insurance Exchange, the deadline is a very strict one. All plan participants (people wanting coverage), must be enrolled by the 15th of the month prior to coverage beginning. That means, if the plan begins on January 1st, the applicant must be enrolled by December 15th. If the person waits until December 16th, coverage will not be made effective until February 1st.

Again, this deadline is for insurance policies that are purchased through the Exchange. Policies which are not purchased through the Exchange are subject to the procedures of the health insurance company with whom they are written.

The scenario referenced above is relatively controllable. If the forms are given out by Human Resources in enough time, anyone should be able to get them done in a timely manner. However, what if a dependent needs to be added to the policy during the middle of the term? For qualifying life events such as the birth of a child, adoption, marriage, divorce and death, the same requirement is enforced. Notice must be provided by the 15th of the month in order to make coverage effective the first of the following month. Otherwise, from the 16th to the end of the month, coverage will be made effective the first of the second following month. For example:

  • If I get married on February 5th and want to add my new wife to my policy, but do not complete the enrollment forms until February 20th, my bride will be covered on April 1st.
  • If a couple who have an existing policy have a baby on August 1st and completes enrollment by August 15th, the baby will be covered under the policy starting September 1st.

For more information and guidance on selecting a policy through the Exchange, or outside of the Exchange, please review the additional articles on our website or contact our office.

Joshua D. Crowder, AAI-M