How to get health insurance if missed open enrollment? Finding coverage when the open enrollment period has passed can feel daunting, but it’s not impossible. This guide will illuminate the path forward, offering solutions and resources to help you navigate the process with ease and confidence, like a warm Minahasan discussion.
This guide details steps to understand coverage gaps, explore special enrollment periods, navigate the marketplace, compare plans, understand appeal processes, and access helpful resources. We’ll look at different situations and options, ensuring you have the information you need to find affordable health insurance.
Understanding Coverage Gaps
The labyrinthine world of health insurance can leave many feeling adrift, particularly those who miss the crucial open enrollment periods. Navigating these complexities is crucial for maintaining continuous coverage and avoiding the perilous void of uncovered medical expenses. This section delves into the specifics of coverage gaps, highlighting the consequences and offering strategies to mitigate potential risks.The annual open enrollment periods, often shrouded in bureaucratic jargon, are critical windows of opportunity for securing or changing health insurance plans.
Failure to act during these designated times can lead to a stark reality: a coverage gap, a period where you lack protection from substantial medical bills.
Open Enrollment Timeframes
Open enrollment periods are carefully scheduled windows of time designed for individuals to review and select health insurance plans. These periods vary by state and plan type, but generally fall within specific dates each year. Missing this window can result in significant delays or even the complete absence of coverage. The precise dates and details of these windows should be verified from your specific state’s health insurance exchange or your employer’s benefits department.
Consequences of Missing Open Enrollment
Missing open enrollment can lead to a significant coverage gap, potentially leaving you exposed to financial ruin in the event of unforeseen illnesses or injuries. This absence of coverage can mean higher out-of-pocket expenses, delayed treatments, and significant financial stress. Failure to enroll during the designated period can lead to costly consequences. You may be forced to rely on emergency rooms for immediate care, which can be far more expensive than preventative care.
The consequences of inaction can be dire.
Types of Health Insurance Plans and Enrollment Periods
Health insurance plans vary widely in their offerings and enrollment periods. Many plans are offered through state-based exchanges, while others are provided through employers. Individual plans, typically found on state exchanges, often have open enrollment periods, but employer-sponsored plans might have different procedures. Some plans might have special enrollment periods, triggered by life events such as marriage or job loss, that may offer an opportunity to obtain coverage outside the typical annual enrollment periods.
Unavoidable Circumstances
While diligently adhering to open enrollment periods is ideal, unforeseen circumstances can sometimes render it impossible. For example, a sudden job loss or a significant life change could necessitate a change in health insurance, occurring outside of the traditional enrollment periods. The inability to enroll during the established timeframe may be unavoidable in circumstances beyond your control. Unforeseen events like job transitions or family situations can sometimes make open enrollment impossible to meet.
Consequences by State (Illustrative Table)
| State | Consequences of Missing Open Enrollment |
|---|---|
| California | Significant financial burden; potential for high out-of-pocket costs. May face longer wait times for care. |
| Texas | Higher likelihood of incurring substantial medical debt; limited access to affordable coverage options. |
| New York | Potentially high out-of-pocket costs; may experience longer wait times for certain procedures. |
| Florida | Significant risk of unaffordable medical bills; difficulty obtaining coverage outside of established enrollment periods. |
| Illinois | High potential for medical debt; limited options for coverage outside of open enrollment. |
This table, while illustrative, provides a general overview. Actual consequences may vary depending on individual circumstances and specific health insurance plans. Specific details should be sought from the relevant state exchange or your employer.
Exploring Special Enrollment Periods (SEPs)
A cruel twist of fate, a sudden life upheaval, or a calculated change in circumstances can leave you stranded without health insurance coverage. But hope remains. Special Enrollment Periods (SEPs) are your lifeline, offering a pathway to secure coverage when traditional open enrollment windows close. These crucial periods are not a mere formality; they represent a chance to obtain necessary healthcare protection during significant life events.Understanding these SEPs is paramount to navigating the often-complex landscape of health insurance acquisition.
Each qualifying event unlocks a unique opportunity for coverage, and proper application is critical to ensuring a seamless transition. Navigating the labyrinth of documentation and application processes can feel daunting, but a clear understanding of the nuances empowers you to seize the opportunity effectively.
Qualifying Life Events for Special Enrollment Periods
Significant life events often necessitate a shift in health insurance plans. These events trigger a Special Enrollment Period, allowing you to enroll in a new plan without facing penalties. The following events typically qualify:
- Marriage: The union of two individuals often brings about a combined household, potentially impacting financial and healthcare needs. This event is a significant trigger for a SEP, enabling couples to secure joint coverage.
- Birth or Adoption of a Child: The arrival of a new family member frequently necessitates adjustments in healthcare coverage. SEPs are designed to provide the needed coverage for this new addition, ensuring the child’s well-being is prioritized.
- Significant Change in Family Composition: Divorce, separation, or the adoption of a child can fundamentally alter the family structure. This can create the need for a different health insurance plan and an SEP is a crucial tool for navigating this shift.
- Loss of Health Coverage: When a prior health insurance plan is lost, an SEP allows you to immediately enroll in a new plan, avoiding a gap in coverage. This ensures continued access to vital healthcare services.
- Significant Health Change: A diagnosis of a serious illness or a change in a pre-existing condition may dramatically alter your healthcare needs. This often necessitates a more comprehensive plan, and an SEP helps facilitate the transition.
- Moving to a New Location: A relocation to a different state or city can lead to a change in eligibility for health plans. SEPs enable you to enroll in a new plan tailored to your new location, minimizing disruption to your healthcare.
- Loss of Employer-Sponsored Coverage: When an employer-sponsored plan is lost, the individual faces a period without coverage. SEPs provide a pathway to enroll in a plan quickly and effectively, mitigating any health coverage disruption.
Documentation Required for Applying for an SEP
Securing a Special Enrollment Period requires presenting compelling evidence. The specific documentation needed can vary based on the event and insurance provider. Accuracy and completeness are essential.
- Proof of Marriage: Marriage certificates, divorce decrees, or legal documents confirming the change in marital status.
- Proof of Birth or Adoption: Birth certificates, adoption papers, or legal documents related to the child’s arrival.
- Proof of Significant Health Change: Medical records, doctor’s notes, or diagnoses from a healthcare professional detailing the specific change in health status.
- Proof of Loss of Coverage: Previous insurance cards, termination letters from previous employers, or proof of the loss of coverage.
- Proof of Loss of Employer-Sponsored Coverage: Letters of termination from the employer, or any other official documents confirming the cessation of employer-sponsored coverage.
Comparison of Application Processes Across Different Insurance Providers
The process of applying for an SEP varies between insurance providers. Understanding these differences is crucial for a smooth transition.
- Some providers might offer online portals for streamlined applications. Others might require in-person visits or mailed applications.
- Different providers may have varying deadlines for submitting documentation. Some providers may allow for extensions, others may not.
- Some providers may require additional documentation specific to the qualifying event.
SEP Types and Eligibility Criteria, How to get health insurance if missed open enrollment
Special Enrollment Periods offer a crucial pathway to securing health insurance outside the traditional open enrollment period. Different types of SEPs cater to various situations.
| SEP Type | Eligibility Criteria |
|---|---|
| Pregnancy-related SEP | Pregnancy is a qualifying event, allowing expectant mothers to enroll in a health plan tailored to their needs. |
| Family Composition Change SEP | Significant changes in family composition, such as divorce or adoption, necessitate a different health insurance plan. |
| Medicaid SEP | Eligibility for Medicaid often necessitates enrollment in a specific health plan. |
Navigating the Marketplace
:max_bytes(150000):strip_icc()/GettyImages-536985963-56880b4a3df78ccc1519640a.jpg?w=700 "Managing Your Dental Care If You Miss The Open Enrollment Window ...")
The path to securing health insurance after missing open enrollment is fraught with complexities, demanding meticulous navigation through the labyrinthine marketplace. Failure to act swiftly and decisively can leave individuals vulnerable, facing the stark reality of inadequate coverage. This perilous journey necessitates a profound understanding of the available options and a steadfast commitment to the application process.
Options for Coverage After Open Enrollment
Individuals who missed open enrollment are not entirely without recourse. A range of options, though not as comprehensive as open enrollment, can still provide access to affordable health coverage. These alternatives often come with specific eligibility criteria and deadlines. The most crucial consideration is the swift initiation of the application process.
Applying for Coverage Outside Open Enrollment
The application process outside of open enrollment differs significantly from the streamlined experience during open enrollment. Rigorous criteria govern eligibility, often focused on qualifying life events. These events can include a change in employment status, a significant family event, or a qualifying illness. The specific criteria are meticulously detailed on the marketplace websites.
Determining Eligibility for Coverage
Eligibility for coverage outside of open enrollment hinges on specific criteria. For instance, a job loss or a marriage can trigger eligibility for a special enrollment period. A documented medical event, like a new diagnosis, might also unlock access. A critical review of personal circumstances is essential to ascertain if a special enrollment period applies. Thorough documentation of any relevant life events is paramount.
Finding and Contacting the Marketplace
Locating the correct health insurance marketplace is crucial. A simple online search for “health insurance marketplace” coupled with the individual’s state will usually yield the desired result. Contacting the marketplace directly is essential. Their representatives can clarify eligibility requirements and assist in navigating the application process.
Step-by-Step Application Guide
- Identify Qualifying Events: Assess personal circumstances for qualifying life events, such as job loss, marriage, birth of a child, or a new diagnosis. Detailed documentation is critical.
- Locate the Marketplace: Use online search engines to find the specific health insurance marketplace for your state. Visit the official website.
- Review Eligibility Criteria: Carefully examine the eligibility criteria for coverage outside of open enrollment on the marketplace website. Understand the specifics of special enrollment periods.
- Gather Necessary Documents: Compile all necessary documents, including proof of income, identification, and any relevant medical records, if applicable. The marketplace website will usually provide a detailed list.
- Complete the Application: Accurately and completely fill out the online application form, providing all required information. Double-check for accuracy before submission.
- Submit the Application: Submit the completed application to the marketplace. Keep a copy of the submitted application for your records.
- Await Notification: Expect a response from the marketplace regarding the application status. Follow up if there is a delay. Be prepared for potential rejections and the steps to appeal.
- Enroll in Coverage: Upon approval, carefully review the plan details and enroll in the chosen coverage. Ensure a complete understanding of the plan’s provisions.
Comparing Health Insurance Options
The labyrinth of health insurance options can feel overwhelming, a treacherous maze of premiums, deductibles, and coverage intricacies. Navigating this terrain requires a discerning eye and a firm understanding of the factors that shape your optimal choice. Choosing the wrong plan can leave you vulnerable, exposed to financial hardship and inadequate care. This crucial step demands careful consideration and a strategic approach.Understanding the nuances of various plans, comparing their costs, and identifying affordable options is paramount to securing comprehensive and financially sound health coverage.
This section delves into the critical aspects of plan selection, providing tools to make informed decisions and ultimately safeguard your well-being.
Factors to Consider When Selecting a Health Insurance Plan
A multitude of factors influence the selection of a suitable health insurance plan. These factors encompass individual needs, financial constraints, and anticipated healthcare utilization. Prioritizing these aspects is crucial to finding a plan that aligns with your circumstances and maximizes benefits.
- Cost: Premiums, deductibles, and out-of-pocket maximums directly impact the financial burden of health insurance. Compare these costs across different plans to identify those within your budget. For example, a young, healthy individual may prioritize lower premiums, while someone with a chronic condition might prioritize lower deductibles.
- Coverage: The breadth of covered services significantly impacts the plan’s value. Consider the extent of coverage for preventive care, hospital stays, prescription drugs, and mental health services. Comprehensive coverage provides a safety net in unexpected circumstances. Examples include pre-existing conditions, specialized treatments, or long-term care needs.
- Network: The network of providers associated with a plan directly affects access to care. Ensure that your preferred doctors, specialists, and hospitals are included in the network to avoid potential out-of-network costs. This factor is crucial to ensure that you can readily access the medical care you need without financial strain.
- Plan Type: Understanding the different types of plans, such as HMOs, PPOs, and POS plans, is essential. Each plan type offers varying levels of flexibility and control over healthcare choices. Different plans will have different costs, network coverage, and levels of required referrals.
Comparing Different Types of Plans
Different health insurance plans cater to diverse needs and preferences. Understanding their characteristics is crucial for informed decision-making.
- Health Maintenance Organizations (HMOs): HMOs typically require referrals to see specialists and often have a limited network of providers. Cost-effectiveness can be a key benefit in some cases. For example, a young person with a primary care physician within the network might find an HMO to be the most suitable option.
- Preferred Provider Organizations (PPOs): PPOs offer broader provider networks and usually allow greater freedom to choose providers. However, out-of-network costs may be higher. A person who travels frequently or requires specialist care outside the local area may find a PPO more beneficial.
- Point-of-Service (POS) Plans: POS plans blend elements of HMOs and PPOs. They offer a degree of flexibility in choosing providers, but cost and coverage can vary significantly depending on utilization of in-network and out-of-network providers.
Finding Affordable Health Insurance Options
Finding affordable health insurance options requires a strategic approach. Explore all available avenues, including government assistance programs and alternative providers.
- Government Assistance Programs: Government subsidies and programs like Medicaid and CHIP can significantly reduce the cost of health insurance, especially for low-income individuals and families. These programs offer critical financial relief to vulnerable populations.
- Marketplace Options: The health insurance marketplace offers various plans, including those tailored for specific needs and budgets. The marketplace allows consumers to compare plans and find those that best meet their requirements.
- Alternative Providers: Independent insurance agencies and brokers can help you navigate the complex landscape of plans, identifying options that fit your specific needs and budget. A trusted broker can help sift through the options, saving you time and effort in the process.
Potential Insurance Providers for Out-of-Enrollment Coverage
Navigating out-of-enrollment coverage necessitates careful research and consideration of potential providers.
- Aetna
- Blue Cross Blue Shield
- Cigna
- UnitedHealthcare
- Anthem
Health Insurance Plan Comparison
The following table provides a simplified comparison of health insurance plans, highlighting key factors:
| Plan Type | Premiums (Estimated) | Deductible | Coverage |
|---|---|---|---|
| HMO | $150/month | $1,500 | In-network primary care, specialist referrals required |
| PPO | $200/month | $2,000 | Wider network, more flexibility in provider choice |
| POS | $180/month | $1,800 | Hybrid approach, some in-network flexibility |
Understanding the Appeal Process
The denial of health insurance coverage can be a crushing blow, especially when faced with unforeseen illness or injury. However, the process isn’t insurmountable. Understanding the appeal process empowers individuals to challenge a denial and potentially secure the necessary coverage. A thorough understanding of the steps, timelines, and documentation required can be the key to regaining access to vital healthcare.
Steps to Appeal a Denial
Appealing a denial of coverage requires a strategic and meticulous approach. Failure to follow the prescribed steps can jeopardize the appeal. Initiating the appeal process promptly is crucial to preserve the opportunity to rectify the situation. Begin by meticulously reviewing the denial letter and identifying the specific reasons for the rejection.
Navigating the complexities of obtaining health insurance outside of open enrollment periods often requires exploring various avenues. While understanding coverage specifics, such as whether health insurance covers cancer treatment, is crucial ( does health insurance cover cancer ), individuals may need to explore special enrollment periods, consider short-term plans, or contact their current provider to assess their options.
Ultimately, the most effective strategy hinges on individual circumstances and the particular provisions of the applicable insurance market.
Timeline for Appealing a Denial
Insurance companies typically establish specific timelines for appealing coverage denials. Failure to adhere to these deadlines can result in the dismissal of the appeal. Diligence in adhering to these time-sensitive procedures is paramount. Seek guidance from the insurer and relevant regulatory bodies regarding the specific timeline applicable to your situation. A missed deadline can be a formidable obstacle.
Documentation Required for an Appeal
A comprehensive appeal requires meticulous documentation. This involves collecting all relevant medical records, supporting documentation, and any other pertinent information that substantiates the need for coverage. Failure to provide sufficient documentation may weaken the appeal. For instance, medical records, diagnoses, and treatment plans can all be pivotal in supporting the appeal. Ensure all supporting documents are organized and readily available.
Reasons for a Denial of Coverage
Insurance companies may deny coverage for various reasons. These may range from eligibility issues to questions regarding the necessity of the requested care. Common reasons include insufficient medical necessity documentation, lack of pre-authorization for certain procedures, and failure to meet eligibility requirements. Understanding the grounds for denial can aid in formulating a compelling counter-argument. For instance, a denial might cite a lack of medical necessity for a particular treatment, a situation that can be countered with comprehensive medical records showcasing the patient’s condition and the efficacy of the treatment in question.
Different Types of Denials
- Eligibility Issues: The individual may not meet the insurer’s eligibility criteria, such as residing in the coverage area or failing to maintain continuous employment. Failure to meet eligibility requirements can lead to a denial. A thorough review of the insurer’s eligibility guidelines is crucial to address any potential gaps in meeting their criteria.
- Medical Necessity: The insurer may dispute the medical necessity of the treatment or procedure. Demonstrating the necessity of the care, often through medical records and expert opinions, is vital. Medical necessity is frequently contested, necessitating a well-prepared and persuasive appeal.
- Pre-Authorization Requirements: Certain procedures or treatments may require pre-authorization from the insurer. Failure to obtain pre-authorization can lead to a denial. Pre-authorization requirements are often stringent and necessitate timely action.
- Coverage Limitations: The insurance plan may have limitations or exclusions that prevent coverage for specific treatments or conditions. A thorough review of the plan documents is essential to understand the coverage limits and exclusions.
Table Outlining the Steps Involved in Appealing a Health Insurance Coverage Denial
| Step | Description |
|---|---|
| 1. Review the Denial Letter | Carefully examine the denial letter for specific reasons for rejection. |
| 2. Gather Supporting Documentation | Compile all medical records, bills, and other relevant documents. |
| 3. Contact the Insurance Company | Initiate contact with the insurance company’s designated appeals department. |
| 4. Present Your Case | Clearly articulate your position and present the gathered evidence. |
| 5. Respond to Requests | Respond to any requests for additional information promptly and accurately. |
| 6. Follow Up | Monitor the appeal process and follow up with the insurance company as needed. |
Resources and Support: How To Get Health Insurance If Missed Open Enrollment
Navigating the labyrinthine world of health insurance can feel overwhelming, especially when facing a coverage gap or seeking alternative options outside open enrollment. This section unveils critical resources and support systems, empowering you to reclaim control and access the assistance you deserve. Arm yourself with knowledge and explore the avenues available to secure affordable healthcare.
Reputable Organizations Offering Assistance
These organizations stand as beacons of support, offering expert guidance and practical solutions. Their dedication to empowering individuals and families facing healthcare challenges is invaluable.
- The National Alliance of Healthcare Access: A nationwide network providing critical information and resources to help individuals understand their options and navigate the complexities of the healthcare system.
- The Health Insurance Counseling and Advocacy Program (HICAP): Operated by the Department of Health and Human Services, HICAP offers free, confidential assistance in understanding health insurance coverage and benefits.
- The Patient Advocate Foundation: This organization dedicates itself to empowering patients, providing invaluable support and resources to help them navigate their healthcare journeys.
- Local Consumer Protection Agencies: Local government agencies are dedicated to protecting consumers’ rights and interests. These agencies often provide guidance and assistance in consumer-related matters, including health insurance.
Contacting State Insurance Departments
State insurance departments serve as essential resources for understanding and navigating state-specific insurance regulations. Their expertise is instrumental in resolving issues, clarifying requirements, and ensuring compliance with regulations.
- State-specific websites provide comprehensive information regarding insurance coverage and policies. A diligent search of your state’s official website will likely yield the specific contact information for their insurance department.
- State insurance departments often maintain complaint resolution processes. These processes allow individuals to file grievances and seek resolution to issues they may encounter with insurance providers.
- Directly contacting your state insurance department can provide personalized support and guidance specific to your situation.
Online Resources for Health Insurance Information
The digital landscape is brimming with resources dedicated to health insurance. These resources offer valuable insights and practical guidance.
- The Centers for Medicare & Medicaid Services (CMS) website: A primary source for information on health insurance plans, coverage, and eligibility criteria.
- State health insurance marketplaces: These platforms provide access to a range of health insurance plans, enabling comparisons and personalized searches based on your needs.
- Independent insurance comparison websites: These platforms allow you to compare different health insurance options, often with detailed plan information and provider networks.
Government Assistance Programs
Government assistance programs provide vital support to individuals and families facing financial hardships. These programs help reduce the cost of healthcare and ensure access for those in need.
| Program | Eligibility Criteria |
|---|---|
| Medicaid | Based on income and financial need, as determined by state-specific guidelines. |
| Medicare | Eligibility depends on age and prior employment history. |
| Affordable Care Act subsidies | Based on income and household size. |
| CHIP | Eligibility is determined by household income and the age of the children. |
Using Online Resources to Find Insurance Options Outside Open Enrollment
Navigating the health insurance landscape outside of open enrollment requires proactive research and utilization of online resources. By understanding the options available, you can ensure continued coverage.
- Special Enrollment Periods (SEPs): Understanding eligibility criteria for SEPs is crucial. These periods offer opportunities to enroll in a health insurance plan outside the traditional open enrollment periods. Familiarize yourself with the various qualifying life events that trigger SEPs.
- Online marketplaces: These platforms often provide opportunities to explore health insurance options even when open enrollment is closed. By accessing these platforms, you can gain insights into available plans and make informed decisions.
Illustrative Examples
Navigating the labyrinthine world of health insurance can feel like a relentless pursuit, especially when open enrollment slips through your grasp. This section delves into specific, hypothetical scenarios, highlighting the steps to secure coverage outside the designated period, and dissecting the available options with their associated costs and coverage implications. Armed with this knowledge, you’ll be better equipped to navigate this often-challenging process.
Hypothetical Scenario: Missing Open Enrollment
Imagine Sarah, a young professional, who diligently avoided the open enrollment period for health insurance. Unexpectedly, she finds herself facing a critical medical need. How does she acquire coverage, and what are her options?
Steps to Secure Coverage
To secure coverage outside of open enrollment, Sarah must first understand the special enrollment periods (SEPs) available to her. These periods offer a lifeline for those facing unforeseen circumstances. Understanding the eligibility criteria and application processes for SEPs is paramount. Next, she must explore the health insurance marketplace to identify available plans. This exploration will reveal different tiers of coverage and associated costs.
Finally, Sarah should meticulously compare the various plans, ensuring they align with her specific needs and budget.
Options Available
Several options present themselves to Sarah in this predicament. She can explore plans through the health insurance marketplace. She might be eligible for a special enrollment period (SEP) if she’s experienced a qualifying life event like a marriage, job loss, or birth. Navigating these options requires careful attention to the specific requirements of each plan and her unique situation.
Comparison of Outcomes
The potential outcomes vary dramatically depending on the chosen plan and the SEP (if applicable). A plan with comprehensive coverage will typically command a higher premium. However, the cost may be offset by the reduced out-of-pocket expenses in case of a significant medical event. A plan with more limited coverage may prove more affordable but may leave Sarah with higher out-of-pocket costs.
Infographic: Finding Coverage Outside Open Enrollment
This infographic visually Artikels the process of securing health insurance outside of open enrollment. It starts with the initial recognition of the need for coverage. Then, it details the search for available SEPs. Next, it illustrates the crucial step of navigating the health insurance marketplace and comparing plans. Finally, it culminates in the selection of a suitable plan and enrollment.
The infographic will include key timelines and resources to guide Sarah through each stage. It will also highlight the potential challenges and solutions along the way.
The infographic will feature a visually appealing layout with clear icons, concise text, and a step-by-step guide to finding coverage outside of open enrollment.
Last Recap
In conclusion, securing health insurance outside of open enrollment, while requiring extra effort, is achievable. By understanding your options, utilizing special enrollment periods, and navigating the marketplace, you can find suitable coverage. This guide has presented a comprehensive roadmap, offering you a clear path to finding the right health insurance plan that fits your needs and circumstances. Remember, you are not alone in this journey.
Seek support from resources and organizations available to help you along the way. Hopefully, this guide has made the process clearer and more manageable.
Helpful Answers
What are some common reasons people miss open enrollment?
Life happens! Sometimes people experience unforeseen circumstances like job loss, marriage, or a change in family status that make it difficult to enroll during open enrollment. Also, some people may simply forget or underestimate the importance of the enrollment period.
What is a Special Enrollment Period (SEP)?
A SEP is a specific time window outside of the regular open enrollment period that allows you to enroll in health insurance. Qualifying life events like marriage, birth of a child, or moving to a new place usually trigger a SEP.
How long does the appeal process take?
The timeframe for an appeal can vary depending on the insurance provider and the specific circumstances. It’s crucial to contact the insurance company and follow their appeal process guidelines carefully to get a clear idea of the expected timeline.
What if I still don’t qualify for an SEP?
If you don’t qualify for an SEP, you can still apply for coverage outside the open enrollment period, but the process might be more complex and eligibility criteria might be stricter.
