Special Enrollment period (SEP)
SEP is a period of time outside of the Open Enrollment period during which you may be eligible to apply for an individual or family health plan. If you experience a qualifying life event, such as getting married, having or adopting a baby, losing your coverage, or permanently moving into a new service area, you may qualify for a SEP.
If you qualify for a Special Enrollment period, you may be able to apply for coverage that starts sooner. Here’s how to apply if you qualify for a SEP:
When can I enroll during a Special Enrollment period?
A Special Enrollment period occurs if you have a qualifying life event. In most cases, you will have 60 days after the qualifying life event to enroll in or make changes to a health plan.
Certain life events, like moving into the Independence Blue Cross coverage area, allow you to apply for a health plan up to 60 days before a qualifying life event. If you are losing health care coverage provided by an employer, you will have up to 60 days before and after this qualifying life event to enroll in a health plan.
When you apply for a Special Enrollment period for the following qualifying life events, you will be sent an Eligibility Notice for Coverage.
This notice will include a list of acceptable documents you may provide to prove your eligibility for the Special Enrollment period. Please provide these documents by the deadline listed in the notice to avoid disruptions to your health care coverage. You must send the documents before you can start using your health care coverage.
What are qualifying life events?
A qualifying life event, also known as a QLE, is a change in circumstance that may allow you to enroll in coverage outside of the annual Open Enrollment period.
Qualifying life events include:
- Adoption/Foster care
- Loss of coverage1
- Permanent move into insurer’s network
- You become a U.S. citizen
For the following qualifying life events, please visit Pennie.com:
- You have a change in income or household status that affects your eligibility for premium tax credits or cost-sharing reductions.
- If you are a member of a federally recognized American Indian tribe or Alaskan Native, you have an open enrollment throughout the year and can change plans as often as once a month.
Timing of qualifying life events and the Special Enrollment period
The following chart provides more details about qualifying life events and the timing of Special Enrollment periods resulting from them.
|Qualifying life event||Effective date of coverage||Special enrollment period||Example|
(Not limited to child only)
|Date of birth||Up to 60 days after the event||Your child is born on May 1. You have until June 29 to apply for an effective date of May 1.|
(Not limited to child only)
|Date of adoption or placement||Up to 60 days after the event||Your child is placed with family on May 1. You have until June 29 to apply for an effective date of May 1.|
|Loss of coverage3
||If the loss of coverage is in the future: the first (1st) of the month following the loss of coverage
If the loss of coverage is in the past: the first (1st) of the month following the date the application was submitted
|Up to 60 days before and up to 60 days after the event||You will be losing health care coverage through your job on May 1 (future date). You may apply for coverage anytime between March 3 and June 29.
|Moved into the insurer’s coverage area
||If within the first 15 days of the month: the first (1st) of the following month after the application has been submitted
On or after the 16th of the month: the first (1st) of the second month following the submission of the application
|Up to 60 days after the event||You are moving into the Independence Blue Cross coverage area effective May 1. You may apply for coverage anytime between April 2 and June 29.
How to apply during a Special Enrollment period
1 Loss of coverage due to voluntarily canceling your health insurance plan, having your plan canceled because you did not pay your premium or because your plan did not meet the requirements as stated by the Health Care Law do not qualify as life events that allow you to enroll during a Special Enrollment Period.
2 This is the date the adopting parents receive the adoptee, regardless of whether papers were filed.
3 If the loss of coverage is due to a Qualified Health Plan decertification, the life event is the official notice of decertification. In all other cases, it is the date the individual loses eligibility for Affordable Care Act compliant plan.