Special enrollment periods: what you need to know to get enrolled

 

 

With almost 17 million people filing for unemployment benefits in the last two weeks, we are trying to keep up with the demand for our expertise from clients and community.

The federal government has not opened a Special Enrollment Period (SEP) specific for COVID-19, but you can still qualify for a Federally Facilitated Marketplace SEP if you recently lost group coverage.

Here are the basics of what you need to know about SEP’s.

 

What is a Special Enrollment Period (SEP)

During the Open Enrollment Period (November 1st – December 15th), we are able to enroll all eligible clients in individual health plans through the Marketplace.

The rest of the year is called a Special Enrollment Period, and there are more restrictions on who we can enroll in health insurance. You can only enroll during the SEP if you have experienced a qualifying life event (QLE).

If you do qualify for a SEP, you need to enroll within a certain timeframe. Depending on your QLE, you will either have 60 days before or after the event to enroll in a Marketplace plan. If you miss this eligibility window, you will not be able to enroll unless two things happen: you have another QLE, or the next Open Enrollment Period begins.

 

What is considered a Qualifying Life Events (QLE)

Here is a list of the most common QLE’s.

For all of the circumstances listed under ‘Changes in residence’, you will need to confirm you had qualifying health coverage for at least one day of the 60 days before your move.

For all of the circumstances listed under ‘Loss of Coverage’, you are ineligible if you voluntarily dropped coverage, or lost coverage because you didn’t pay the premium or didn’t upload documentation. This chart was supplied by HealthSherpa for agents to use as a guide for SEP eligibility determination:

List of common qualifying life events (QLEs)

 

There are other circumstances, such as becoming a US citizen or leaving incarceration, that would also qualify you for an SEP.