Having health care coverage is one of the most important things for ourselves and our family.
Life happens and circumstances can change all the time, which is why special enrollment periods exist. These are times when you’re allowed to enroll in health insurance outside the yearly open enrollment period.
One of the most important things to understand about this is that you must experience a life event to qualify. This will determine whether you are eligible for a special enrollment period. So, what is considered a qualifying life event?
It can be several things, but ultimately, it’s a change in your situation. The four basic types of qualifying events are:
- Loss of health coverage. This includes losing existing health coverage -- job-based, individual and student plans; losing eligibility for Medicare, Medicaid or CHIP; and turning 26 or losing coverage through a parent’s plan.
- Changes in the household. This includes getting married or divorced, having or adopting a child and a death in the family.
- A change in residence. This includes moving to a different ZIP code or county; a student moving to or from the school they attend; a worker moving to or from where they live and work; and moving to or from a shelter or other transitional housing.
- Other qualifying events. This includes changes in your income that affect the coverage you qualify for; gaining membership in a federally recognized tribe or status as an Alaska Native Claims Settlement Act Corporation shareholder; becoming a U.S. citizen; leaving incarceration; and AmeriCorps members who are beginning or ending their service.
According to University Community Care Plan by Community First, special enrollment periods give you the opportunity to choose a plan that fits your health needs. University Community Care Plan (UCCP), a qualified plan through the Marketplace at Healthcare.gov, is the only local nonprofit health plan in Bexar County.
Here’s a list of questions Community First Health Plan navigator Sonia Gallegos recommends asking before choosing a plan:
1. What kind of doctors can you see?
University Community Care Plan (UCCP), also known as Community First, is an exclusive provider organization, which means you have access to nationally recognized University Health and University of Texas Health doctors and specialists.
2. What are the requirements on referrals?
Referrals can be time consuming to get to the specialist you need. Gallegos said Community First removes that roadblock by not requiring a referral to see in-network specialists so you can get the care you need more quickly.
3. Are telehealth services provided?
Telehealth services are a great option when you have general health questions, need a prescription refill, need to discuss lab results or when you’re just not feeling your best.
4. What is the preferred process for prescriptions?
Making a trip to a pharmacy is not always convenient. Gallegos said Community First offers mail-order prescriptions at no extra cost.
5. What kind of coverage does your plan provide?
You should get access to a full range of covered services that can help when you are facing a serious illness or emergency. This should include things like primary care and specialist visits, preventative care and screenings, diagnostic services, urgent care, chiropractic care, pediatric vision exams, hearing aids and more.
6. Are in-home urgent care services provided?
With in-home urgent care services -- like Community First covers-- you can book an appointment and a professional medical team will go to your home to provide treatment.
7. What added benefits are offered?
Added benefits can include a 24/7 nurse advice line, an array of health and wellness programs, and even educational opportunities.
Gallegos said Community First offers all of this and more, with personalized help to find the best plan for you and your family, including those no longer eligible for Medicaid benefits. Plus, most people qualify for premium tax credits, a tax credit you can use to lower your monthly insurance payment (called your premium).
If you qualify for a special enrollment period, help is available in English and Spanish and in-person at the Community First Avenida Guadalupe Office, located in San Antonio at 1410 Guadalupe Street, suite 222.
Click or tap here, go to CommunityFirstMarketplace.com or call 888-512-2347 to learn more about University Community Care Plan.