What Is A Special Enrollment Period?

Missing Open Enrollment doesn’t always mean you have to wait until next year to get health insurance. In some situations, you may qualify for a Special Enrollment Period (SEP), which allows you to enroll in a health insurance plan outside of the annual Open Enrollment window. A Special Enrollment Period is a limited amount of time outside of Open Enrollment when you can enroll in or change your health insurance plan due to certain life events.

Most SEPs last 60 days from the date of the qualifying event. However, qualifying for an SEP is not as simple as it used to be. Over the past year, insurance regulations have become stricter, and gone are the days when you could self-report life changes. Now, most SEP applications require documentation to prove you experienced an involuntary loss of coverage. That being said, what are some of the circumstances that qualify you for a Special Enrollment Period?

You may qualify for an SEP if you experience an event such as:

• Losing employer-sponsored health insurance

• Losing Medicaid or CHIP coverage

• Turning 26 and aging off a parent’s plan

• Getting married

• Getting divorced and losing spouse benefits

• Having a baby or adopting a child

• Moving to a new coverage area

Each event has its own rules and documentation requirements. If documentation is not submitted on time, your SEP application may be denied. Depending on your situation, acceptable documentation may include:

• A termination letter from your employer

• A COBRA exhaustion notice

• Proof of Medicaid denial or termination

• Pay stubs showing loss of employment

• Marriage certificates

• Birth certificates

• Proof of address for a move

An important detail many people don’t realize is that the loss of coverage must usually be involuntary. Meaning, if you voluntarily cancel your health plan, choose not to renew coverage when it is still available, do not sign up during your enrollment window, or stop paying your premiums, causing your plan to terminate, you will not qualify for a SEP and are stuck until Open Enrollment rolls around.

SEP rules can be confusing, especially now that the verification process is stricter than ever. If you recently lost coverage or experienced a major life event, get in touch! We are happy to help you determine whether you qualify for a Special Enrollment Period and walk you through the enrollment process step-by-step.