Special Enrollment Period for Victims of Domestic Abuse or Spousal Abandonment
All insurers and health maintenance organizations (HMOs) that offer comprehensive health insurance coverage in the individual market should provide a special enrollment period to victims of domestic abuse or spousal abandonment regardless of whether the coverage is offered on or off the NYSOH. This special enrollment period is consistent with the Department of Health and Human Services (HHS), which has created a permanent special enrollment period for victims of domestic abuse or spousal abandonment under its authority to grant special enrollment periods for exceptional circumstances in 45 CFR 155.420(d)(9). Likewise, this special enrollment period is consistent with the New York State of Health (NYSOH), which has determined that this special enrollment period is available for individual coverage on the NYSOH. Insurance Law 4328(b)(4) requires individual coverage to have the same special enrollment periods on and off exchange. Accordingly:
- The special enrollment period should be made available for individual coverage outside the NYSOH starting April 15, 2016 to any member of a household who is a victim of domestic abuse, including unmarried and dependent victims within the household, as well as victims of spousal abandonment, including their dependents.
- For applications received by the 15th of the month, coverage should be effective on the first day of the following month. For applications received after the 15th of the month, coverage should be effective on the first day of the second following month.
- Insurers and HMOs may include either an item on the application or request a separate statement from the applicant attesting to their eligibility for the special enrollment period. Insurers and HMOs should not require that the applicant have been a victim of domestic abuse or spousal abandonment within a specified period of time. Insurers and HMOs should not require any additional proof of eligibility or apply overly burdensome requirements on applicants seeking to use the special enrollment period.
For more information on this special enrollment period and definitions of domestic abuse and spouse abandonment, see the HHS guidance available at HHS Guidance on Victims of Domestic Abuse and Spousal Abandonment (PDF).