special enrollment periods (SEP)

What is a Special Enrollment Period?

A Special Enrollment Period (SEP) is a time during which an eligible person may enroll in a Qualified Health Plan or change from one plan to another because of a Qualifying Life Event (QLE) such as:

  • Involuntary loss of Minimum Essential Coverage (MEC)

  • Reaching maximum age for dependent coverage  

  • Marriage 

  • Birth, placement for adoption, placement in foster care or gaining a court-ordered dependent 

  • Access to new individual plans due to permanent move or change in service area  

  • Non-calendar year expiration of coverage (coverage ends on a date other than December 31st) 

  • Other events as decided by the Health Insurance Marketplace 

 

Note: If you have already enrolled in coverage using your current Qualifying Event and you want to make a plan change, you will need to wait for the next Open Enrollment period or until you experience a new Qualifying Event.

 

What is required to apply for coverage during a Special Enrollment Period?

A person applying for coverage as the result of a Qualifying Event must provide valid supporting documents showing that a Qualifying Event occurred within 60 calendar days of the date the application was received which:

  • Caused the individual to lose Minimum Essential Coverage (such as aging off a policy or loss of employment), or

  • Gain access to new coverage options (such as adding a dependent or moving to a new service area)

How do I know if the documents I have to support my Qualifying Event are valid?

Documents to support the Qualifying Event must include the reason for loss of coverage or the reason for gaining access to new coverage options and the last day of coverage or first day of access to new coverage options. Documents to prove Minimum Essential Coverage must include the last day of coverage or current paid to date of the policy. Additionally, to be considered valid, supporting documents must:

  1. Be from a legitimate source (on letterhead, website or from company email) like an insurer, employer, policy administrator or government agency 

  2. Be dated within 90 calendar days of the Qualifying Event date provided on the application

What is not considered a valid Qualifying Event?

The following are not considered valid Qualifying Events and applications received for these reasons will be withdrawn:

  • Loss of short-term or temporary coverage

  • Voluntarily opting out of affordable employer-provided coverage

  • Voluntarily canceling coverage before the policy renewal or end date

  • Expiration of travel insurance

  • Loss of State or Federal benefits or assistance due to failure to provide necessary documents or verification

  • Loss of coverage due to failure to pay full premium  

  • Ending participation in a Medical Cost Sharing group 

  • Gaining voluntary guardianship of a dependent (not authorized by a court)

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