Individual and Family Plan Enrollment Periods
Individual and Family Plan enrollment periods are specific times that you can enroll or make changes to your health care coverage for yourself or your family. If there isn't a valid enrollment period, you can’t enroll or make changes. The fastest and easiest way to determine when you're eligible to enroll is to call us at 1-866-322-2824 (TTY: 711) to speak with a Via Benefits licensed benefit advisor, who will ask a series of questions to determine if you currently qualify for an enrollment period. Our licensed benefit advisors specialize in health insurance for retirees. They go through annual training and certification to ensure they can help you make an informed and confident decision.
If you need to contact Via Benefits Insurance Services for help evaluating or changing plans, be sure to reserve a time to call to speak with a benefit advisor. You can reserve a time to call on the website or by calling us at 1-866-322-2824 (TTY: 711). If an appointment isn't available, call us at your convenience or complete your enrollment online.
If you have a non-Marketplace plan and change to a plan with a new carrier, you must contact your current insurance carrier and notify them of the cancellation after you receive a confirmation from you new plan. Otherwise, you may end up paying a premium for your old plan and a premium for your new plan. Ask your insurance carrier for confirmation in writing regarding your cancellation.
Open Enrollment Period (OEP)
The OEP is November 1 through January 15 each year for most states. The state or federal government tells you if the OEP for your state is anything other than November 1 through January 15. During the OEP, you can enroll in a health plan or change your health plan. If you enroll November 1 through December 15, the plan's effective date will be January 1 of the following year. If you enroll December 16 through January 15, the effective date is February 1. State-based marketplaces (SBMs) may have different dates and rules.
No action is required during the OEP if you‘re satisfied with your current coverage. Your plans automatically renew unless your plan is being discontinued. The carrier or Marketplace will notify you of any changes to the plan.
Consider Whether You Need To Call Us During Open Enrollment
Please call us at 1-866-322-2824 (TTY: 711) if any of these situations apply to you, and you would like to consider changing your plan:
Significant change in health status.
Significant increase in premiums.
Your out-of-pocket costs have increased for your current medications.
You've moved to a new state or ZIP Code, and your plan wasn't changed at the time of your move. Always call to review your plan immediately when moving to ensure continuation of coverage.
Your plan has been canceled.
Your primary care physician is no longer included in your plan's network.
Health plan changes - Plans often change from one year to the next. Even if you've been satisfied with your plan, and you don't expect to change, it may be a good idea to sign into your account on the website and ensure you're still in the right plan for your evolving needs.
Special Enrollment Periods (SEPs)
If you need to change your health plan outside of the OEP (November 1 through January 15), there are specific situations that may allow you to change plans. These chances to make changes are called SEPs. You qualify for an SEP if you’ve had certain life events, such as changes in household or residence or loss of health insurance, including loss of group health coverage. We go over a few of the most common SEPs here, but because there are many different SEPs, the best way to determine whether you qualify for one is to call us.
Loss of Health Insurance: You may qualify for an SEP if you lost coverage (or were denied Medicaid/CHIP). If you have an SEP for loss of health insurance, your enrollment period begins 60 days before you lose coverage and lasts for 60 days after the loss of coverage date. The effective date for the plan you enroll in will be the first of the month following enrollment. Voluntary loss of coverage does not grant SEP.
Changes in Household: You may qualify for an SEP if in the past 60 days you or anyone in your household got married; had a baby, adopted a child, or placed a child for foster care; got divorced or legally separated and lost health insurance; or died. Note: Divorce or legal separation without losing coverage doesn’t qualify you for a SEP.
Changes in Residence: You may qualify you for an SEP if you move. However, moving only for medical treatment or staying somewhere for vacation doesn’t qualify you for an SEP. You must prove you had qualifying health coverage for one or more days during the 60 days before your move unless you are moving from a United States territory or from a foreign country.