Enrollment Periods

2021 Special Enrollment Period Issued by Executive Order | February 15 - August 15

President Biden announced a new Special Enrollment Period so individuals who do not have insurance or individuals who want to change coverage can enroll in a health insurance plan on the Federal Marketplace. This new Special Enrollment Period runs from February 15, 2021 through August 15, 2021. You can learn more information by viewing our frequently asked questions.

Current Members

Because you are currently enrolled in a 4-star quality-rated1 OptimaFit® plan, there’s nothing you need to do if you want to keep your current coverage. Your benefit coverage will not change. Any deductibles or coinsurance levels already met will remain. As long as you continue to make your monthly premium payments, you will continue to receive benefits including those below through December 31, 2021:

  • Access to high-quality board-certified providers and facilities in your community
  • Free preventive care services when received from an in-network provider or facility
  • 24-hour access to virtual healthcare
  • Access to free health and wellness programs
  • Value-added benefits including discounts on health and wellness services
  • Value-added benefits for Emergency Travel Assistance
  • Exemplary service and more!

Benefit Questions? Please call member services at 1-866-514-5916

Looking for Coverage?

To learn about your plan options during this Special Enrollment Period issued by Executive Order, talk to an OptimaFit Personal Plan Advisor at 1-844-206-3208. We can help you find the perfect plan!

Open Enrollment Period

Open Enrollment Period is the yearly timeframe when individuals can enroll in a health insurance plan. Open Enrollment Period runs from November 1 - December 15. You do not need a qualifying life event to enroll in a health insurance plan during the Open Enrollment Period.

Your Open Enrollment Checklist

  1. Visit our Health Insurance 101 video library to help you understand terminology and how deductibles, copayments and coinsurance work.
  2. Find out if your employer will offer coverage or if you need to purchase an individual health insurance plan.
  3. If you are under the age of 26 you may be able to stay on a parent’s health plan until your 26th birthday. Speak with your parents about your options.
  4. Gather information on your household income. You may qualify for a subsidy to reduce your insurance costs or you may qualify for another government program.
  5. Set your budget. Larger premiums usually mean lower out-of-pocket costs for prescription drugs, office visits, and procedures, and vice versa. How much you can afford for a premium and out-of-pocket expenses are both important considerations when selecting a health plan for you and your family.

Learn More About Our Plans

Special Enrollment Period

Special Enrollment Period is a time outside of the annual Open Enrollment Period when an individual can enroll in a health insurance plan.

An individual must experience a qualifying life event and provide proof of eligibility in order to qualify. During the Special Enrollment Period, individuals may enroll in the Affordable Care Act (ACA) health insurance on or off the Health Insurance Marketplace or change from one Qualified Health Plan to another.

Individuals and/or their dependents have 60 days from the time of the triggering event to enroll in a health plan and obtain coverage. 

Certain life events like getting married, having a baby, or losing other health coverage enable you to enroll outside the Open Enrollment Period.

  • Job-based plans may have different Open Enrollment Periods. Check with your employer.
  • You can apply and enroll in Medicaid or the Children's Health Insurance Program (CHIP) any time of year.

What Are Examples of Qualifying Life Events?

Qualifying life events are significant changes in your life that enable you to enroll in a health insurance plan outside of the Open Enrollment Period. These qualifying life events may cause you to lose your health coverage or have a change in family status or residency.

Losing Your Health Coverage

  • Losing coverage because your current health insurance carrier left the service area
  • Losing job-based coverage for any reason including resigning, getting laid off, or getting fired
  • Expiring COBRA coverage
  • Losing coverage under your parents’ plan at age 26
  • Getting divorced or legally separated (resulting in loss of coverage)
  • Losing eligibility for Medicaid or the Children’s Health Insurance Program (CHIP)

Note: Losing coverage that doesn’t qualify as minimum essential coverage doesn’t qualify you for a Special Enrollment Period. Learn more at HealthCare.gov.

Change in Your Household Size

  • Getting married
  • Having a baby
  • Adopting a child or placing a child for adoption or foster care
  • Death of family member (causing you to lose eligibility in your current plan)

Change in Circumstance

Change in Status

  • Getting released from jail or prison
  • Gaining citizenship or lawful presence in the U.S.

For more information on required documentation, please visit HealthCare.gov.

How Soon Can Coverage Start During a Special Enrollment Period?

Most qualifying life events allow you to enroll and begin coverage 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. For example:

  • If you enroll on May 10, your coverage starts June 1.
  • If you on enroll May 17, your coverage starts July 1.

This works the same as it does during the Open Enrollment Period. However, there are a few exceptions which allow same-day effective coverage to begin:

  • Birth of child
  • Adoption of child

How Long Does a Special Enrollment Period Last?

A Special Enrollment Period is triggered by a qualifying life event and typically lasts for 60 days. However, the Special Enrollment Period may vary based on the type of qualifying life event.

Qualifying Life Event Special Enrollment Period (SEP)
Getting Married Up to 60 days after the event.
Having a baby, adopting or placing a child for adoption Up to 60 days after the event.
Losing your health coverage Up to 60 days before and up to 60 days after the event.
Moving outside your plan's coverage Up to 60 days after the event.
Note: Only triggers SEP if it's not during open enrollment.
Gaining U.S. citizenship Up to 60 days after the event.
Note: Only triggers SEP if it's not during open enrollment.
Change in income or household status that affects eligibility
for premium tax credits or cost-sharing reductions
Up to 60 days after the event.
Note: Only triggers SEP if it's not during open enrollment.
Being denied Medicaid or CHIP Up to 60 days after the event.
Release from prison or jail Up to 60 days after the event.
Note: Only triggers SEP if it's not during open enrollment.
Hardship Exemption* Up to 60 days after the event.

What is a Hardship Exemption?

*A hardship exemption is an exceptional circumstance, and it triggers a 60-day Special Enrollment Period. Examples of exceptional circumstances are unexpected hospitalizations, natural disasters, or temporary cognitive disability. Other hardships may include enrollment errors created by HealthCare.gov, your broker or by your insurance carrier. For more information, please visit HealthCare.gov.

1CMS scores qualified health plans (QHPs) offered through the Exchanges using the Quality Rating System (QRS) based on third-party validated clinical measure data and QHP Enrollee Survey responses. CMS calculates ratings yearly on a 5-star scale. Ratings may change from year to year. Due to the COVID-19 virus, CMS did not collect data from health plans during the 2020 calendar year. Therefore, the ratings reflect data previously provided by health plans in 2019.

Special Enrollment Period (SEP)

The 2021 Special Enrollment Period issued by Executive Order runs February 15 - August 15.

Frequently Asked Questions