HealthCare Benefits

Individual Family Solutions

For many individuals and families entering into the individual market for their healthcare is new and can cause some uncertainty. Effective 2020 California, under the Affordable Care Act will enact the mandate, meaning in 2020 not having health coverage will result in a penalty. 

As we know, not having medical coverage could come with substantial risk. We understand that purchasing and having health coverage is personal and it is our responsibility to help align you in the best possible plan at the best possible price.

 

We have helped our clients save north of $30 Million since the (ACA) has started and will continue to thrive in helping our community understand the importance of healthcare coverage.

Income Guidelines

Side by Side Comparisons

People who experience a qualifying life event can newly enroll in a health plan through Covered California even outside the open-enrollment period. Currently enrolled members who experience a qualifying life event can change their coverage or choose a new plan. This is called special enrollment. 

 

Even if you only need coverage for a few months, look to Covered California throughout the year for your health insurance needs and even if you think you might not qualify, you should contact us to make certain. 

Special Enrollment (Qualifying Life Events)

Lost Coverage

Moved 

Turned 26

Just Married

Had a Baby

 

You recently lost or will soon lose your coverage

  • You lose Medi-Cal coverage

  • You lose your employer-sponsored coverage

  • Your COBRA coverage is exhausted. 

  • (Note: Not paying your COBRA premium is not considered loss of coverage.)

  • You are no longer eligible for student health coverage.

  • You turn 26 years old and are no longer eligible for a parent's plan

  • You turn 19 years old and are no longer eligible for a child-only plan.

Deadlines to Enroll After a Qualifying Life Event

SDMI Insurance and Financial Services can also help you determine, on a case-by-case basis, that you experienced an exceptional circumstance that could allow for a special-enrollment period. 

 

You have 60 days from the date on which the qualifying life even happens to enroll in a Covered California health insurance plan or change their existing plan.

 

If 60 days pass and you do not sign up for health coverage, you will have to wait until the next open-enrollment period.

Start Dates and Avoiding Gaps in Coverage

You will need to plan ahead to avoid gaps in health coverage. In general, the start date for coverage depends on the date of enrollment. If you enroll by the 15th day of the month, coverage will start on the first day of the next month. If you enroll after the 15th day of the month, coverage will start on the first day of the second month. For example, if you enroll on April 10, coverage will start on May 1. If you enroll on April 16, coverage will start on June 1.

There are a few exceptions to the regular start-date rule:

 

  • For a loss fo health coverage, such as losing Medi-Cal or job-based coverage, the new health plan would start on the first day of the next month following enrollment.

  • If you get married and apply during the special-enrollment period, your new health plan would start on the first day the next month following enrollment.

  • If you have a child, adopt a child place a child in adoption or foster care, and you use a special-enrollment period, you can choose to have coverage will start on the date of the birth, the adoption or the placement for adoption or foster care, or on the first day of the next month following enrollment.