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Special Enrollment Period

Special Enrollment Periods occur when a specific event happens allowing a person to make changes.  Special enrollment periods include but are not limited to:

  • Gaining or becoming a dependent
  • Gaining status as a citizen, national, or lawfully present individual
  • Loss of minimum essential coverage (ie loss of Medicaid eligibility, termination of a QHP “qualified health plan”) except if enrollment is based on failure to pay premiums
  • Loss of affordable employer-sponsored coverage
  • Determination that an individual is newly eligible or ineligible for premium tax credits or a change in eligibility for cost sharing reductions.
  • Permanent move to an area where different QHPs are available
  • Other exceptional circumstances identified by the Marketplace

In these cases, the effective date again depends on when the selection is received.

SEP

In the case of the birth or adoption of a child, the effective date is a little different.  In this case the effective date can be the actual date of birth or date of adoption as long as the Marketplace is notified in a timely manner.  Premiums in this case would be pro-rated for the month, based on when the child was added to the plan.

In most cases, SEPs will extend for 60 days from the date of the triggering event.  Under certain circumstances, such as the pending loss of minimum essential coverage due to the termination of a QHP, a SEP may begin before the triggering event takes place.

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