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Jan 12

Individual Medical Updates for NJ, NY, and PA for 2018

Important information for prospective individual medical enrollees who did not enroll at open enrollment:

Amerihealth (NJ):

  • Coverage effective dates can only be 1st or 15th of the month.
  • For when coverage is ending mid-month, Amerihealth will enroll 1st of that month month, if the application is received prior to the 1st. If received after the 1st, the next effective date can only be for the 15th of the month or 1st of the following month.

Horizon Blue Cross Blue Shield of NJ:

  • Coverage effective dates are 1st or the 15th of the month.
  • The only exceptions to the above are the following:
    • Birth, adoption, foster care, child support, or court order – coverage is effective as of the date of event
    • Death of policyholder – coverage is effective day after prior coverage ends
    • Future Loss of coverage – coverage is effective the day after prior coverage ends if application is received prior to the loss. Ex: losing coverage 6th of the month–if app is received prior to 2/6, it will be processed for that date; if receive after, it will only be processed for a 2/15 date.

Independence Blue Cross (PA):

  • Coverage effective date can only be 1st of the month; if an individual is losing coverage mid-month, they will be effective the 1st of that month if they apply prior to the 1st, so as to avoid a lapse in coverage.

Oscar (NJ, and NY):

  • Coverage effective date: 1st of the month
  • Exceptions to the above are noted here: NY Link and NJ Link

As a reminder, individual medical applications must be received no later than the day prior to the requested effective date. If a deadline falls on a weekend, the completed applications must be received by the prior business day. Anything received after the deadline will need to be processed on the next available effective date.

As a reminder, please note that a certificate of creditable coverage (COCC) and/or HIPAA certificate alone often do not suffice as proof of loss of coverage, as these often do not indicate the exact reason for loss, which is required to enroll mid-year. Additional information will usually be required.