KB Category Employees

Can I leave my employer-sponsored insurance (ESI) in the middle of the plan year?

When someone enrolls in health coverage through their employer, they are generally making that selection for the full plan year under federal rules. They may only make changes during their employer’s annual open enrollment period. However, federal rules provide specific scenarios when an employee can make mid-year plan changes. To make any mid-year changes, the employee must experience a qualifying mid-year election change event recognized by federal rules and allowed by their employer. Some examples of these qualifying events include: Marriage, divorce, or legal separation Change in number of dependents (for example, childbirth or adoption) Involuntary loss of coverage under another plan Change in employment status For any questions regarding mid-year plan changes, including dropping coverage through your employer, it’s important to speak to your employer.[1] If you have questions and would like to speak with someone from the Health Connector, please email connector.policy@mass.gov For more information, please see: What to Know If You Get Help Paying for Health Insurance from Both the Health Connector and Your Employer – Massachusetts Health Connector Job-based Insurance Affordability Calculator - Premium Tax Credit Department of Labor information on Continuation of Health Coverage – COBRA Massachusetts Division of Insurance MiniCobra Continuation of Coverage Benefits Guide Tax Treatment of Cafeteria Plans – Final Regulation __________ [1] See Tax Treatment of Cafeteria Plans on IRS.gov: https://www.irs.gov/pub/irs-regs/td8921.pdf

Can I get Health Connector coverage if I do not want my employer-sponsored insurance (ESI)?

You can switch out of your employer’s plan to a Health Connector plan during your employer’s annual open enrollment period. Even if you could continue on your employer’s plan, the ending of that plan would trigger a special enrollment opportunity for you to sign up for Health Connector coverage. An employee is not eligible to receive subsidies through the Health Connector if their employer-sponsored coverage is considered affordable (according to a federal definition) and provides minimum value coverage. However, as noted below, an employee is not eligible to receive subsidies through the Health Connector if their employer-sponsored coverage is considered affordable (according to a federal definition) and provides “minimum value” coverage. If you are not in your employer’s annual open enrollment period, you would need to experience a qualifying mid-year election change event to leave the employer’s plan. If you leave your employer’s plan, you may apply for and enroll in Health Connector coverage. If you do not have a qualifying mid-year election change event to leave your employer’s plan, and you still want to apply for and enroll in Health Connector coverage, please know that you will need to experience a qualifying event to enroll with the Health Connector and you would be covered by both your employer plan and Health Connector plan. That means that you would be paying for double coverage.

Can I get subsidies through the Health Connector if I choose to leave my employer-sponsored insurance (ESI)?

An employee is not eligible to receive subsidies through the Health Connector if their employer-sponsored coverage is considered affordable (according to a federal definition) and provides “minimum value” coverage. Employer-sponsored coverage is considered affordable if the portion of the annual premium you must pay for self-only coverage does not exceed the annually adjusted percentage of household income set by the IRS, which is 9.02% in 2025. Employer-sponsored coverage is considered to meet “minimum value” standards if the plan covers at least 60 percent of the total allowed cost of benefits expected to be incurred under the plan. The plan also must provide substantial coverage of in-patient hospitalization and physician services. Most employer plans meet this standard. The Health Connector has a tool located here to help you calculate the affordability of your job-based coverage.

Consumer Protections Against Surprise Billing through the No Surprises Act

The No Surprises Act protects people from getting surprise medical bills when they have an emergency, get services from an out-of-network provider at an in-network facility, or get services from an out-of-network air ambulance service provider. It also establishes a process for payment disputes between plans and providers. It provides new opportunities for dispute resolution for people who are uninsured or self-pay individuals when they receive a medical bill that is much greater than the good faith estimate they get from the provider. If you have private health insurance, the new protections - which started in 2022 - will ban most types of surprise bills. If you're uninsured or decide not to use your health insurance for a service, you can get an estimate of the cost of care before your visit. If you disagree with your bill, you may be able to dispute the charges. Here are some frequently asked questions about the No Surprises Act: Am I protected against surprise medical bills? Starting in 2022, the federal No Surprises Act (NSA) established new protections that prevent surprise medical bills for individuals covered under group and individual health plans. These new protections ban the most common types of surprise bills. What types of surprise medical bills does the No Surprises Act protect against? The No Surprises Act protects people covered under group and individual health plans from receiving surprise medical bills when they receive: most emergency services; non-emergency services from out-of-network providers at in-network facilities; and services [...]

Qualifying Life Events (QLEs) – Terminating Coverage

Throughout the year your circumstances may change which may make you eligible for a Special Enrollment Period (SEP). If you have a baby, you or your dependent gain or lose other coverage, etc., you may be able to change your plan, enroll in a plan for the first time, add or drop family members, or terminate your plan. You must report the event WITHIN 30 DAYS of the event to be eligible for an SEP. Once you report the event in your account, DC Health Link will guide you through the options available to you and your family. Step 1: Report the Qualifying Life Event In each employee's account, consumers will have the option to report a qualifying life event. Please select the life event that applies to the primary subscriber or dependent (For Example: "Drop coverage due to new eligibility"). Note: There are three different pages of QLEs that can be viewed by clicking the arrow Step 2: Enter the Date of QLE Report the date of your qualifying event by selecting the date from the calendar or keying in the date. Then click "Continue". Step 3: Confirm the QLE If you are eligible to apply for a SEP, a green confirmation box will appear. Click "Continue" to proceed. Step 4: Confirm Household Once you have confirmed your household, click the "Continue" button. Step 5: Select Waive Coverage Click "Waive Coverage" for the plan that you wish to terminate. Step 6: Select Waiver Reason Select the reason why [...]

Qualifying Life Events (QLEs) – Removing a Dependent

Throughout the year your circumstances may change which may make you eligible for a Special Enrollment Period (SEP). If you have a baby, you or your dependent gain or lose other coverage, etc., you may be able to change your plan, enroll in a plan for the first time, add or drop family members, or terminate your plan. You must report the event WITHIN 30 DAYS of the event to be eligible for an SEP. Once you report the event in your account, the Health Connector will guide you through the options available to you and your family. Step 1: Report the Qualifying Life Event In each employee's account on www.MAhealthconnector.org, consumers will have the option to report a qualifying life event. Please select the life event that applies to the primary subscriber or dependent (For Example: Divorced or ended domestic partnership, Drop Family Member due to new Eligibility). Note: There are three different pages of QLEs that can be viewed by clicking the arrow Step 2: Enter the Date of QLE Report the date of your qualifying event by selecting the date from the calendar or keying in the date. Then click "Continue". Step 3: Confirm the QLE If you are eligible to apply for a SEP, a green confirmation box will appear. Click "Continue" to proceed. Step 4: Update Household You will be able to add/remove any members of your household. In the next steps you will have the option to add/remove any dependent from the policy [...]

Qualifying Life Events (QLEs) – Adding a Dependent

Throughout the year your circumstances may change which may make you eligible for a Special Enrollment Period (SEP). If you have a baby, you or your dependent gain or lose other coverage, etc., you may be able to change your plan, enroll in a plan for the first time, add or drop family members, or terminate your plan. You must report the event WITHIN 30 DAYS of the event to be eligible for an SEP. Once you report the event in your account, the Health Connector will guide you through the options available to you and your family. Step 1: Report the Qualifying Life Event In each employee's account on www.MAhealthconnector.org, consumers will have the option to report a qualifying life event. Please select the life event that applies to the primary subscriber or dependent (For Example: Married, Had a Baby, Lost or will soon lose other Health Insurance). Note: There are three different pages of QLEs that can be viewed by clicking the arrow Step 2: Enter the Date of QLE Report the date that of the qualifying life event. Step 3: Confirm the QLE Click "Continue" to proceed. Step 4: Add Member to Household Adding a member to the household does not add them to the policy, in the next steps you will have the option to add/remove any dependent from the policy. Step 5: Enter dependent information Enter the date of birth, gender and relationship to primary. Check the "NO SSN" box if the SSN [...]

New Employers – How to Offer Health Coverage through the Health Connector

Who is this guide for? Employers who offer coverage through the Health Connector for the first time. New employers may be offering health coverage to their employees for the first time, OR they may have previously offered employer-sponsored coverage outside of the Health Connector. Get Started - Setup Your Account Click on the "CREATE ACCOUNT" menu and select "Employers". Or, click here now to create an account. Create Your Employer Account Fill out your email address and create a password (8 characters minimum) and then click the "CREATE ACCOUNT" button. NOTE: Please be sure that you record your password somewhere secure. You'll use your email address as your login in the future. Next, provide some basic information about you and your business. As the point of contact for the small business, provide your name and date of birth. Then, provide information about the small business, including company legal name, DBA name, federal employer identification number (FEIN), entity kind, and primary office location then click the "Create Employer" button. If you have more than one office location click "Add Office Location" and fill in the information for your other location(s) before proceeding to "Create Employer". NOTE: Brokers setting up accounts for Employers MUST use the information for the POC for the business and not their own information when filling out this section. Add Your Eligible Employees to Roster Creating Your Employee Roster: IMPORTANT - Make sure that the date of birth and SSN is accurate for each of your [...]

New Employees – How to Enroll in Health Coverage through the Health Connector

Who is this guide for? This guide will walk employees without a Health Connector account through setting up their employee account, selecting a plan, or waiving coverage. Get Started - Setup Your Account Go to the Create Employee Account page fill out your email address and create a password (8 character minimum) and click the "Create account" button. Please be sure to record your password somewhere secure. You'll use your email address as your login in the future. Your Information and Matching to your Employer Your Information - Step 1: Fill out your personal information (name, DOB and SSN) and then click the red "CONTINUE". Your Information - Step 2: The Health Connector will match you to your employer by verifying your date of birth (DOB) and Social Security Number (SSN). Click "Continue" if the employer information displayed is correct. NOTE: If you are not matched to an employer, confirm you have entered your SSN and DOB correctly above. If you are still not matched to your employer, confirm your employer has your correct SSN and DOB and that you have been added to the employee roster. Your Information - Step 3: Fill out your contact information where needed, such as your address, email address, and phone number. The pre-populated information was submitted by your employer but may be edited by you. NOTE: By default, you opt into receiving electronic communications. To change this selection, select "only paper communications" or "paper and electronic communications" from the dropdown menu [...]