A special enrollment period (SEP) allows you to enroll in an ACA-compliant plan (on or off-exchange) if you have a qualifying life event. A qualifying event triggers a special enrollment period (SEP) for an individual or family to purchase health insurance outside of the regular annual ACA open enrollment period. ACA Open Enrollment period- November 1st to December 31st. Coverage goes in effect January of the following year.
- What are examples of qualifying events?
- Birth or Adoption of a child
- Marriage
- Divorce: if the exchange or insurer counts it as quilifiying event or the divorce triggers a loss of other coverage.
- Loss of coverage: the coverage you are losing must be considered minimum essential coverage.
- Permanent move to area where different health plans are available: you must have coverage prior to the move.
- Change in Income: become eligible for subsidy and or increase in income that moves you out of Medicaid coverage.
- Grandfathered or Grandmothered plan’s non-calendar-year renewal
- Becoming a U.S. citizen or lawfully present resident (only applicable in the exchange)
- Time Frames:
- Coverage is only available during the annual open enrollment period. With a special enrollment, AKA “trigger” of “qualifing event” it allows coverage for outside the annual open enrollment.
- Special enrollment period for employer (SEP)-sponsored plans generally only have 30 days to make a changes due to a qualifying event.
- Indivdual Market plans typically allow up to 60 days for a qualifying event.
- Documents: When you enroll during a Special Enrollment Period (SEP), you will be required to provide certain documentation that proves your qualifying event took place. The documentation varies depending on the event, but overall it need to:
- Birth certificate, Offical court adoption documents
- Marriage certificate or Finalized Divorce degree
- Proof of loss of coverage- example: Official letter from hospital, insurer, or employer.
- If moving requires you to change plans, you will need to prove you have current coverage
- Paystub or annual taxes provides documentation for change in income
- See Full list by click here
- Maryland Resources Links:
- Maryland Health Connection: https://www.marylandhealthconnection.gov/
- Maryland Department of Health: https://mmcp.health.maryland.gov/Pages/home.aspx (Medicaid information)
- Maryland Health Education and Advocacy Unit: https://www.marylandattorneygeneral.gov/Pages/CPD/HEAU/default.aspx
- Health Care Access Maryland: https://www.healthcareaccessmaryland.org/
- Maryland Senior Health Program: https://mhcc.maryland.gov/consumerinfo/longtermcare/SeniorHealthInsuranceProgram.aspx
Do you have an SEP question that I didn’t answer? Contact me through our website, I am happy to answer any questions.