Insurance 101

Open Enrollment for Health Insurance Begins Nov. 1

Kandis Suhar is a member of the board of directors of the Western Reserve Association of Health Underwriters and the owner of Suhar Consulting. Suhar specializes in employee benefits. She received her law degree from the University of Akron.

An Individual health insurance plan is a major medical policy purchased directly by the consumer to insure one or more persons in a family, all of whom are under the age of 65.

Individual plans generally do not cover dental or vision, but those can be purchased separately on an individual or family basis.

One of the most critical aspects to understand about individual health insurance is the open enrollment period.

Whether purchasing a policy through the federal exchange at the website Healthcare.gov, through your insurance agent or directly from an insurance carrier, enrollment must take place between Nov. 1 and Dec. 15.

Missing the open enrollment period results in being locked out of making a purchase for the following year. The only exception is qualifying for a “special enrollment period” if you incur a specific life event. These include losing employer health insurance, giving birth or adopting a child or moving out of your current health plan’s service area.

The special enrollment period is defined by federal regulation and documentation proving the life event must be provided when enrolling.

Losing insurance because of unpaid premiums does not qualify as an under a special enrollment period.

Take note that the deadline to purchase a plan is 60 days from the date of the qualifying event. All individual plans begin on the first of the month.

Other very important aspects of individual health insurance plans are the following:

  •  Network of providers (doctors and facilities).
  •  Deductible (when the carrier starts paying benefits).
  •  Copay, if applicable.
  •  Out-of-pocket maximum.
  •  Qualifying for advanced premium tax credits to offset the cost of monthly premiums.

These terms will vary with the insurance company and plan level being offered.

Be sure to use the provider search on the insurance company’s website when searching for the physicians and facilities that are important to your family.

Both Ohio and Pennsylvania use the federal exchange, Healthcare.gov, as the marketplace for individuals seeking advanced tax credits.

Regardless of whether your family qualifies for tax credits, the website is an important source of information for those seeking individual health insurance plans.

Using the website, consumers can determine if they qualify for advanced premium tax credits or a special enrollment period. Find the specific plans being offered in a particular county and compare plans using a comparison tool.

To learn more, visit Healthcare.gov, the state of Ohio insurance site or speak to your insurance agent.

Published by The Business Journal, Youngstown, Ohio.