The Special Enrollment Period, or SEP, is the designated period of time time outside of the open enrollment period (OEP) during which an individual or family has the right to sign up for health coverage.
The open enrollment period has varied during the first few years of Obamacare’s existence. In 2016 the open enrollment period began on November 1st 2015 and ran through January 31st 2016, and this three month period (November 1st through Jan 31st) is planned for 2017 and going forward. The period of time between open enrollment periods is by default the Special enrollment period. However, health insurance shoppers only qualify to purchase health insurance during SEP if they have a qualifying life event.
Qualifying Life Events
In the health insurance marketplace established by Obamacare, you qualify for SEP only if one or more of the following qualifying life events have taken place within the previous 60 days:
- Loss of Health Coverage. This can be in the form of a) losing employer-sponsored coverage b) losing individual health coverage c) losing eligibility for Medicaid or CHIP d) losing eligibility for Medicare or e) losing coverage you were getting via a family member
- Changes in Household Size. These changes might be: a) having a baby — or otherwise adopting one b) getting married c) getting divorced or d) someone on your plan dies and as a result you are no longer eligible for the plan you had.
- Changes in residence. Changes in residence might include a) moving to a new home b) a student moving to or from college c) a seasonal worker moving to or from the place they live and work d) moving to or from transitional housing.
- Change in eligibility for Coverage. Examples include: Being enrolled in Marketplace coverage and report a change that makes you: a) Newly eligible for help paying for coverage. b) Ineligible for help paying for coverage. c) Eligible for a different amount of help paying for out-of-pocket costs, like copayments. and more.
- Enrollment or Plan Error. Although uncommon, qualifying circumstances would be things such as: you weren’t enrolled in a plan or were enrolled in the wrong plan because of: a) Misinformation, misrepresentation, misconduct, or inaction of someone working in an official capacity to help you enroll b) A technical error or another Marketplace-related enrollment delay. c) The wrong plan data (like benefit or cost-sharing information) was displayed on HealthCare.gov at the time that you selected your health plan.
- Other qualifying events. Miscellaneous qualifying events include a) changes in income b) Americorps members starting or ending their service.
The Six categories above include examples of situations that would qualify shoppers for enrollment during SEP. CMS has released a streamlined summary of SEP qualifying events.
Special Enrollment Period (SEP) Video
courtesy of US Dept. of Health and Human Services (2:48)
If you believe that you have a qualifying life event (QLE) and would like to enroll in a health insurance plan during the special enrollment period, fee free to call toll free (888) 592-5448 and a courteous licensed insurance professional can assist you over the phone or if you prefer, you can compare quotes online.