The New York State Department of Financial Services ("DFS") recently took action to ensure that victims of domestic violence and victims of spousal abandonment have the opportunity to enroll in the individual health insurance marketplace at any time of the year. DFS’ recent action applies regardless of whether the coverage is offered on or off the New York State of Health ("NYSOH") exchange.

DFS’ action is consistent with the U.S. Department of Health and Human Service’s ("HHS") special enrollment period for exceptional circumstances outlined at 45 CFR 155.420(d)(9) and the NYSOH’s requirement at N.Y. Ins. Law 4328(b)(4), which also requires the same special enrollment periods on and off exchange for individual enrollees.

DFS’ action supports the more global effort to help victims break the cycle of violence and gain independence.

What this means is:

Now, victims of domestic violence and spousal abandonment are free from the restraints of “standard enrollment”(November 1 to January 31), and they can apply year-round, offering flexibility for enrolling in necessary health insurance for themselves and their dependents. Victims of abuse no longer have to feel pressured to remain with an abusive partner in order to assure appropriate health coverage for themselves and their dependents.

What insurers and HMOs offering comprehensive health insurance coverage need to know:

The “special enrollment period” was made available for coverage outside the NYSOH starting April 15, 2016.

Who does this include?

Any member of a household who is a victim of domestic violence, including unmarried and dependent victims within the household; and victims of spousal abandonment and their dependents.

For more information on the definitions of domestic violence and spousal abandonment, see the HHS' guidance.

When is coverage triggered?

When applications are received by the 15th of the month, the effective date will be the first day of the following month.

When applications are received after the 15th of the month, the effective date will be on the first day of the second following month.

Attestation regarding Coverage:

DFS’ recent guidance notes that “[i]nsurers and HMOs are permitted to include either an item on the application or request a separate statement from the applicant attesting to the applicant’s eligibility for the special enrollment period.”

The application form or separate statement should not include “a request that the applicant have been a victim within a specified period of time or that the victim provide additional proof of eligibility" or satisfy other "overly burdensome requirements by using the special enrollment period.”


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