|Market Place Individual Policies Off-the-Exchange Plans Short Term Medical (STM) Plans |
We offer you the choice of helath plans on the Market Place or off the Market Place based on your qualifications. We are also able to provide you the option of a Short Term Medical policy up to 364 days.
Market Place Plans - Affordable Care Act
These are individual health insurance plans that provide your standard policy benefits designated by the Affordable Care Act (ACA). Market Place plans
are also sometimes referred to as "on the Exchange". These policies are guaranteed coverage with a limited enrollment period.
allow for a credit based on your income to reduce your monthly premium. Depending on income and family size, the premium may be subsidized. The subsidized premium is considered as taxable income. The policies are issued by a limited number of companies within the geographical area.
After the Open Enrollment Period has closed, you are unable to purchase a policy from the exchange unless you have a qualified Life Changing Occurance. The most common of these are below.
Life changes that can qualify you for a Special Enrollment Period
Changes in household
You may qualify for a Special Enrollment Period if you or anyone in your household in the past 60 days:
- Got married. Pick a plan by the last day of the month and your coverage can start the first day of the next month.
- Had a baby, adopted a child, or placed a child for foster care. Your coverage can start the day of the event — even if you enroll in the plan up to 60 days afterward.
- Got divorced or legally separated and lost health insurance. Note: Divorce or legal separation without losing coverage doesn’t qualify you for a Special Enrollment Period.
- Died. You’ll be eligible for a Special Enrollment Period if someone on your Marketplace plan dies and as a result you’re no longer eligible for your current health plan.
Changes in residence
Household moves that qualify you for a Special Enrollment Period:
- Moving to a new home in a new ZIP code or county
- Moving to the U.S. from a foreign country or United States territory
- If you're a student, moving to or from the place you attend school
- If you're a seasonal worker, moving to or from the place you both live and work
- Moving to or from a shelter or other transitional housing
Note: Moving only for medical treatment or staying somewhere for vacation doesn’t qualify you for a Special Enrollment Period.
Important: You must prove you had qualifying health coverage for one or more days during the 60 days before your move. You don't need to provide proof if you’re moving from a foreign country or United States territory.
Loss of health insurance
You may qualify for a Special Enrollment Period if you or anyone in your household lost qualifying health coverage in the past 60 days OR expects to lose coverage in the next 60 days.
Coverage losses that may qualify you for a Special Enrollment Period:
- Losing job-based coverage
You may qualify for a Special Enrollment Period if you lose health coverage through your employer or the employer of a family member, including if:
- You lose health coverage through a parent or guardian because you're no longer a dependent.
- Important: Losing coverage you have as a dependent doesn't qualify you for a Special Enrollment Period if you voluntarily drop the coverage. You also don't qualify if you or your family member loses coverage because you don't pay your premium.
- Losing individual health coverage for a plan or policy you bought yourself
You may qualify for a Special Enrollment Period if you lose individual health coverage, including if:
- Your individual plan or your Marketplace plan is discontinued (no longer exists).
- You lose eligibility for a student health plan.
- You lose eligibility for a plan because you no longer live in the plan’s service area.
- Your individual or group health plan coverage year is ending in the middle of the calendar year and you choose not to renew it.
Important: Losing individual coverage doesn’t qualify you for a Special Enrollment Period if you voluntarily drop coverage, if you lose coverage because you didn’t pay your premiums, or if you lose Marketplace coverage because you didn’t provide required documentation when the Marketplace asked for more information.
- Losing eligibility for Medicaid or CHIP
You may qualify for a Special Enrollment Period if you lose Medicaid or the Children’s Health Insurance Program (CHIP) because:
- You lose your eligibility. For example, you may have a change in household income that makes you ineligible for Medicaid, or you may become ineligible for pregnancy-related or medically needy Medicaid.
- Your child ages off CHIP.
- Losing eligibility for Medicare
You may qualify for a Special Enrollment Period if you become no longer eligible for premium-free Medicare Part A.
You don’t qualify for a Special Enrollment Period if:
- You lose Medicare Part A because you didn’t pay your Medicare premium.
- You lose Medicare Parts B, C, or D only.
- Losing coverage through a family member
You may qualify for a Special Enrollment Period if you lose qualifying health coverage you had through a parent, spouse, or other family member. This might happen if:
- You turn 26 (or the maximum dependent age allowed in your state) and can no longer be on a parent’s health plan.
- You lose job-based health coverage through a family member’s employer because that family member loses health coverage or coverage for dependents.
- You lose health coverage through a spouse due to a divorce or legal separation.
- You lose health coverage due to the death of a family member.
- You lose health coverage through a parent or guardian because you’re no longer a dependent.
- Important: Losing coverage you have as a dependent doesn’t qualify you for a Special Enrollment Period if you voluntarily drop the coverage. You also don’t qualify if you or your family member loses coverage because you don’t pay your premium.
More qualifying changes
Other life circumstances that may qualify you for a Special Enrollment Period:
- Changes that make you no longer eligible for Medicaid or the Children’s Health Insurance Program (CHIP)
- Gaining membership in a federally recognized tribe or status as an Alaska Native Claims Settlement Act (ANCSA) Corporation shareholder
- Becoming newly eligible for Marketplace coverage because you became a U.S. citizen
- Leaving incarceration
- Starting or ending service as an AmeriCorps State and National, VISTA, or NCCC member
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These policies are similar to the policies "on-the-Exchange", such as limited enrollment period, however, there would be no opportunity for a premium credit. These policies may have additional benefits not included in a Market Place policy.
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Short Term Medical (STM) Plans
STM policies provide limited duration insurance coverage for 30 to 364 days, which varies by state. Not all states allow
for durations of 364 days. STM policies provide flexible temporary coverage. It is important that you understand what you’re buying so you can make a fully informed
choice for you and your family.
Why STM insurance?
STM insurance plans provide insurance coverage during life transitions. When you are between
group insurance or individual major medical policies, STM insurance policies help pay for covered
medical expenses due to unexpected illnesses or injuries. Covered expenses may include
diagnostic physician visits, emergency room treatment, hospital stays, surgery, intensive care and
more, but do not include maternity care or outpatient prescription drugs.
STM insurance policies are affordable. STM provides limited benefits and requires you to
answer medical history questions in order to qualify for coverage.
Select from various benefit levels which best meet your insurance and premium needs. You
can also add other coverage such as dental insurance or a discount prescription drug program.
Discount prescription coverage is not insurance.
Coverage can begin as early as the day following acceptance of your online application. In
addition, policy forms and ID cards as well as claims information are available online.
Keep the following in mind as you plan for your needs and explore your options:
• STM plans do not meet the Minimum Essential Coverage requirements under the ACA and
may result in a state tax penalty. STM plans are designed to provide temporary healthcare
insurance during unexpected coverage gaps.
• The ACA-compliant medical plans are guaranteed issue, meaning you cannot be denied
coverage based on your health history. STM plans are underwritten, which means you must
answer a series of medical questions when applying for coverage. Based on your answers,
you may be declined for coverage.
• Unlike the ACA plans, which are required to cover the 10 Essential Health Benefits (EHB),
STM policies are not required to cover EHBs at the same benefit level as an ACA plan.
Policies will vary in what they cover, so you should check your policy’s details carefully.
An STM policy may be right for you if you:
• Have missed the open enrollment period and aren’t eligible for special enrollment under
• Are waiting for your ACA coverage to start
• Are waiting for health insurance benefits to begin at a new job
• Are looking for coverage to bridge you to Medicare
• Are needing an alternative to COBRA
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