Make Changes To Your OptimaFit Plan

Have you had a change in circumstance and need to update your health insurance coverage, even when it’s not during Open Enrollment? Are you self-employed and want to know what other health insurance options are available to you? Do you need to cancel your current coverage? We can help you.

Types of Plan Change

Special Enrollment Period

Sometimes life can present you with changes that can affect your health insurance coverage.  When this happens, you may qualify for a Special Enrollment Period that will enable you to make changes to your current plan outside of the annual open enrollment period.

Examples of Qualifying Life Events

Limited Time To Make Changes

You have 60 days from the date of a triggering event to make changes to your existing plan. If you miss it, you will have to wait until the next annual open enrollment period—and that means you and your family won’t have the insurance coverage you need.

Coverage Start Dates

Enrollment works the same as it does during the annual Open Enrollment Period: coverage will begin the first day of the next month if you enroll by the 15th of the month. If you enroll after the 15th of the month, your coverage will begin the first day of the following month. However, there are a few exceptions, which allow same-day effective coverage to begin:

  • Birth of child
  • Adoption of child

Examples of Qualifying Life Events

You Lose Your Health Insurance Coverage

  • Your current health insurance carrier leaves the service area.
  • Your job-based coverage ends for any reason, such as you resign, you get laid off, or you get fired.
  • Your COBRA coverage expires.
  • You age off your parents’ plan at age 26.
  • You get divorced or legally separated (resulting in loss of coverage).
  • You lose eligibility for Medicaid or the Children’s Health Insurance Program (CHIP).

Note: If you lose coverage that doesn’t qualify as minimum essential coverage, you may not qualify for a Special Enrollment Period. Learn more at healthcare.gov.

There's a Change In Your Household Size

  • You get married.
  • You have a baby.
  • You adopt a child or place a child for adoption or foster care.
  • A family member dies, causing you to lose eligibility in your current plan.

Change In Residence or Taxable Income

  • You permanently move outside your plan’s coverage area.
  • Your income increases or decreases, affecting eligibility for premium tax credits or cost-sharing reductions.

You Experience An Exceptional Circumstance or Hardship

  • A hardship can be an unexpected hospitalization, a natural disaster, or a temporary cognitive disability.
  • Other hardships may include enrollment errors created by healthcare.gov, your broker, or by your insurance carrier.

For more information—including required documentation—please visit healthcare.gov.

Move From a Marketplace Plan To a Non-Marketplace Plan

Whether it’s during the annual open enrollment period or the result of a qualifying life event, when you switch from a plan you purchased directly through healthcare.gov to a plan sold directly by Optima Health (or vice-versa), there are some important factors to consider:

  • If you were receiving federal subsidies and/or a cost sharing reduction, you will lose the assistance and pay full price by going directly through Optima Health
  • If it is not Open Enrollment, you must make sure you are eligible to make a change to your insurance. If you are not sure about your eligibility or have any questions, please call your broker or you can call us at 
    1-800-741-4825.
  • You must cancel your current plan before you can enroll in a new plan.

Options For Self-Employed Individuals

If you are self-employed and meet some basic criteria, you may be eligible to purchase a Small Group plan. Review the qualifications, browse plans, and request a quote for additional information.

Cancel Your Plan

We would hate to see you go, but if you have to leave us we want to make sure you’re prepared.

  • If you cancel your Individual & Family Plan, you may not be able to re-enroll until the next annual open enrollment period, which could leave you and your family without the coverage you need.