Guide to Special Enrollment Periods (sep)



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i | SEP Reference Chart, Updated February 2017
Guide to Special Enrollment Periods (SEP)
A Reference Chart for Special Enrollment Period Triggers and Timing
The marketplace open enrollment period is the time each year when people can newly enroll in a plan or change to a different plan through the marketplace (also known as an exchange. But certain events that occur during the year can trigger a special enrollment period (SEP), when a person maybe able to newly enroll in a marketplace plan or change to a different plan. This chart lists the various events that can trigger a SEP in the marketplace, the timing for when people can access these SEPs, and when coverage through a particular SEP becomes effective. Users of the chart should know The qualifying events that trigger the SEPs in the chart apply in all states, regardless of whether the marketplace is operated by the federal government or the state. States or
State-Based Marketplaces (SBMs) may create additional special enrollment opportunities.
• The chart shows certain situations where states have the ability to implement exchange options For states using the Federally Facilitated Marketplace (FFM) technology,
Healthcare.gov, the exchange options are not being used at this time, except where noted. Consumers in SBMs need to check with the marketplace in their state on the implementation of exchange options. Although the chart focuses on marketplace coverage, most of the SEP qualifying events listed in the chart also apply to the individual health insurance market outside of the marketplace. The exceptions are those related to citizenship status, incarceration, American Indian and Alaska Native status, plan display errors, resolution of data-matching issues, and exceptional circumstances.
• Many SEPs are triggered when either an individual or a member of the individual’s family experiences a qualifying event. Once a SEP is triggered, that SEP is available to all family members, regardless of who experienced the qualifying event.
• An individual who is eligible to enroll in or change plans through a SEP generally has 60 days from the qualifying event to select a plan. For some qualifying events such as losing other coverage, an individual also has 60 days prior to the qualifying event to select a plan. This can help people setup health coverage in advance when they know a change is going to occur so they don’t experience a coverage gap. Some SEPs are only triggered if an individual is already enrolled in a qualified health plan (QHP) or if the individual had other minimum essential coverage in the months prior to experiencing a qualifying event. This reference chart indicates when this is the case. All consumers who want to enroll during a SEP will need to attest that the information they provide in their application about their eligibility fora SEP is true. For some of the most common qualifying events that trigger a SEP, consumers living instates using the FFM technology will be asked to provide documentation of the qualifying event. The marketplace may followup with some consumers, who will need to provide further verification of the qualifying event to prove eligibility fora SEP. Beginning June 2017, anew pilot program is scheduled to begin that will require FFM consumers to provide documentation of an event that triggers a SEP before their coverage becomes effective.




Definitions for sep purposes
Sep reference chart
Loss of pregnancy-related medicaid coverage
Expiration of non-calendar year plan
Newly becoming lawfully present
Current employer plan no longer considered qualifying employer
Plan or benefit display error



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