Failing to Enroll in New Health Coverage Within Time Limits
The federal HIPAA protections allow only a 63 day gap (days of no coverage) between old and new health coverage. If you have a pre-existing condition, this means you will need to retain your previous coverage while transitioning to new coverage so that there is not a break in coverage of more than 63 days. If you don't, and your new plan imposes pre-existing condition exclusionary periods, you will be subject to them. In California, if your new coverage is with a fully-insured plan, your prior coverage was from an employer, and you lost that coverage because your employment ended, or because your employer stopped offering or contributing to health coverage, you are allowed to have up to 180 days without coverage.
Confusing Initial and Open Enrollment Periods
There are distinct differences between initial and open enrollment periods.
The initial enrollment period is the first time employer-sponsored or association-affiliated coverage is offered to you. If you don’t sign up during the initial enrollment period, pre-existing condition exclusionary periods may be longer than they otherwise would be.
An open enrollment period is the annual period of time that you are allowed to make changes to your benefits. During this time period you are allowed to change, add or delete coverage.
Confusing Group and Individual Health Coverage
In some cases, employers or associations will offer to pay for individual health coverage. In those cases, you may not be eligible for the employer-sponsored protections. Contact the California Department of Insurance, the Calfirornia Department of Managed Health Care (DMHC), or the United States Departement of Labor. The DMHC has a helpful chart that tells you which agency to contact.
