District of Columbia: DC Health Link offers SEP for those who didn't know about the mandate penalty & more
DC Health Link to Offer Even More Opportunities for Residents to Get Covered
- DCHBX Executive Board Votes to Allow Pre-Natal Special Enrollment Period and Four Other New Opportunities
Washington, DC – With Open Enrollment recently concluded, District residents and small businesses have new opportunities to sign up for health insurance coverage through DC Health Link. The DC Health Benefit Exchange Authority (DCHBX) Executive Board recently adopted recommendations from its Standing Advisory Board to create four Special Enrollment Periods (SEP) and an extended open enrollment period for DC small businesses.
The Special Enrollment Periods involve pregnancy—in which a pregnant woman and her dependents can enroll in individual market or small business coverage; reinstatement when customers were enrolled in auto-payment and were terminated due to credit card changes or expirations; and two SEPs associated with the District of Columbia individual responsibility requirement to have health insurance—one allowing taxpayers who first learn of the local individual responsibility requirement when they file their taxes for 2019 to enroll in coverage and a second allowing taxpayers who are new DC residents to enroll in coverage. The Executive Board also voted to allow an Extended Employer Open Enrollment Period for 2020 in the small business marketplace, where small businesses can enroll without minimum participation and contribution requirements.
“We listened to District residents and small business owners who told us about these particular circumstances and hardships to obtain or maintain coverage,” said Diane C. Lewis, M.P.A., Chair of the DC Health Benefit Exchange Authority Executive Board. “As an Executive Board, we want to make sure that District residents have every opportunity available to them to enroll in quality, affordable health insurance.”
- Pregnancy SEP: A pregnancy is now considered a qualifying life event for enrollment throughout the year. A Special Enrollment Period is available to pregnant women, and their dependents, allowing enrollment in individual market or small business coverage. A pregnant woman and her dependents can enroll in new coverage or change their existing coverage on DC Health Link. The special enrollment period is triggered based on the date a health care practitioner confirms the pregnancy. A pregnant woman can enroll retroactively starting coverage the month that her pregnancy is confirmed. She also has up to 60 days after confirmation of pregnancy to enroll in individual coverage and 30 days to enroll in her employer’s coverage if the employer offers coverage through DC Health Link’s small group marketplace.
- Reinstatement Following Auto Payment SEP: A SEP is now available to residents enrolled in an individual market plan to reinstate their prior coverage if their coverage was terminated due to a declined payment through a credit card or debit card auto-payment arrangement. To be eligible for this SEP, the customer must have successfully established the auto-payment arrangement with their insurance company directly. Reinstatement will result in continuous coverage in the same plan. The SEP would not be available if the reason for the declined payment was that the individual voluntarily terminated the auto-payment arrangement or there were insufficient funds for the payment.
- Individual Responsibility Requirement SEPs: The District of Columbia enacted a local individual responsibility requirement, modeled after the previous federal requirement, which became effective January 1, 2019. A SEP will be available to residents who learn about the individual responsibility requirement during the tax filing season this year, giving those residents a 60-day window to enroll in individual market coverage from when they learn of the individual responsibility requirement or based on their tax filing deadline. A separate SEP will be available to new District residents, giving them a 60-day window to enroll in coverage upon becoming a District resident.
- Small Business Open Enrollment 2020: SHOP Open Enrollment is extended through 2020 to allow small businesses to offer coverage even if they can’t meet the minimum contribution and participation requirements. This is the first time that small businesses can enroll anytime during the year without having to contribute at least 50% toward employees’ premiums and without having participation by two-thirds of their employees who don’t have coverage elsewhere.
Click here for more information on these four new enrollment opportunities.
The most recent Open Enrollment Period for individuals and families in the District of Columbia concluded February 5, 2020. For District residents eligible for any of these new enrollment opportunities, there are 25 private health insurance options from CareFirst Blue Cross Blue Shield and Kaiser Permanente for individuals and families. Small businesses have 156 different options from three United Health Companies, two Aetna companies, Kaiser Permanente and Care First Blue Cross Blue Shield. Residents eligible for Medicaid can enroll year round.
The Affordable Care Act provides individuals, families, and small businesses in the District of Columbia with affordable options for quality health insurance. DC Health Link is the District’s online health insurance marketplace which allows visitors to shop, compare, and enroll in coverage that fits their needs and budgets.
In 2019, DC Health Link provided health insurance to almost 23,000 residents through the individual marketplace and more than 101,000 people through the small business marketplace. Washington, DC has the second lowest uninsured rate among all states in the nation, with almost 97 percent of District residents covered. Since opening for business in 2013, DC Health Link has helped cut the District’s uninsured rate in half.