Frequently Asked Questions

Medicare

When is the Medicare Advantage Open Enrollment Period?

The Medicare Advantage Open Enrollment Period starts January 1 and ends March 31 every year.  During this period this period, you can switch Medicare Advantage plans or leave a Medicare Advantage plan and return to Original Medicare.

When is the Medicare Open Enrollment Period?

Every year, Medicare’s open enrollment period is October 15 – December 7.  During this period all people with Medicare can change their Medicare health plans and prescription drug coverage for the following year to better meet their needs.

Individual / Family

When is Open Enrollment for ACA?

Open Enrollment starts November 1st for health coverage for the next plan year.  Coverage can start as soon as January 1st.  December 15th is the last day to enroll in or change plans for coverage to start January 1st.  January 1st coverage starts for those who enroll in or change plans by December 15th and pay their first premium.  January 15th Open Enrollment ends and this is the last day to enroll in or change health plans for the year.  After this day, you can enroll in or change plans only if you qualify for a Special Enrollment Period.  February 1 Coverage starts for those who enroll in or change plans December 16th through January 15th and pay their first premium.

What is a Special Enrollment Period?

A time outside the yearly Open Enrollment period when you can sign up for health insurance.  You qualify for a Special Enrollment Period if you have had certain life events, including losing health coverage, moving, getting married, having a baby (or adopting a child) or if your household income is below a certain amount.  Depending on your Special Enrollment Period type, you may have 60 days before or 60 day following the event to enroll in a plan.

Do you have to show proof of a Special Enrollment Period?

When you apply you must attest that the information you provide on the application is true, including the fact that you qualify for a Special Enrollment Period.  You may be required to submit documents that confirm your eligibility to enroll based on the life event you experience.

When does BCBS term a dependent turning 26 off of either a Group Plan or an Individual/Family Plan?

BCBS will term the dependent the last day of the month they turn 26.

When an individual enrolled in an Individual/Family plan turns 65 does the policy terminate automatically?

No, the policy doesn’t terminate automatically because the individual turned 65.

Where can my client get their 1095-B form from BCBS?

BCBSIL 1095-B forms are available in Blue Access for Members.  Members can also call the number on the back of their ID card or can visit the BCBSIL web page TaxInfoIL.com

Group

If someone is cancelled off of a BCBS Group Health Plan on the 13th of the month are they covered until the end of the month?

No, if a member is cancelled in Blue Access for Employers “as of” the 13th of the month their last day of coverage was the day prior.  For example: Jane Doe cancelled as of 1.1.2023, her last day of coverage was 12.31.2022.

When does BCBS term a dependent turning 26 off of either a Group Plan or an Individual/Family Plan?

BCBS will term the dependent the last day of the month they turn 26.

How long do you have to add a newborn baby onto a Group Health Plan?

You must submit an application within 31 days of the birth of a newborn child for coverage to continue beyond the 31 day period or you will have to wait until the group’s open enrollment period to enroll the child.

Where can my client get their 1095-B form from BCBS?

BCBSIL 1095-B forms are available in Blue Access for Members.  Members can also call the number on the back of their ID card or can visit the BCBSIL web page TaxInfoIL.com

How many hours do you have to work to be considered Full Time?

A Full Time Employee means an employee of the employer who is regularly scheduled to work a minimum of thirty (30) hours per week.

Can a group member change plans outside of the Group’s Open Enrollment Period?

If the member has a Special Enrollment Period they may apply for or change coverage for themselves.  They must apply for or request a change in coverage within 31 days from the date of a Special Enrollment Event.  The member should refer to their certificate booklet for a list of qualifying Special Enrollment Events.

How does BCBSIL handle billing when you add or cancel a member on a Group Plan?

For a group that has a 1st of the month billing date

  • If you add a member between the 1st and 15th of the month, BCBSIL will bill for the entire month.
  • If you add a member from the 16th to the end of the month, BCBSIL will not bill for the month.
  • If you cancel a member between the 1st and the 15th of the month, BCBSIL will not charge for the month.
  • If you cancel a member from the 16th to the end of the month, BCBSIL will charge for the entire month.

For a group that has a 15th of the month billing date

  • If you add a member from the 16th to the 1st of the month, BCBSIL will bill for the entire month.
  • If you add a member between the 1st and 15th of the month, BCBSIL will not bill for the month.
  • If you cancel a member from the 16th to the 1st of the month, BCBSIL will not charge for the month.
  • If you cancel a member between the 1st and the 15th of the month, BCBSIL will charge for the entire month.

COBRA / IL State Continuation

How long does IL State Continuation Coverage last?

In general, the maximum period of coverage under Illinois Continuation (mini-COBRA) is twelve (12) months after the date the insurance stopped because your employment was terminate or your hours were reduced below the minimum required by the group plan.

Who is Eligible for IL State Continuation?

IL State Continuation is available to the employee and eligible dependents who were continuously covered under the group plan for 3 months prior to the qualifying event.

How long does COBRA Coverage last?

COBRA requires that continuation coverage extend from the date of the qualifying event for a limited period of 18 or 36 months.  The length of time depends on the type of qualifying event that triggered the COBRA rights.  When the qualifying event is the covered employee’s termination of employment or reduction in hours of employment, qualified beneficiaries are entitled to 18 months of continuation coverage.

Who is Eligible for COBRA Continuation?

COBRA is available to a qualified beneficiary who was covered by the group health plan on the day before a qualifying event occurred that caused them to lose coverage.