A Special Enrollment Period (SEP) is a time outside the annual Open Enrollment period when individuals may enroll in or change qualified health plans (QHPs). Individuals qualify for SEPs based on certain life events. Note that consumers can also qualify for an SEP during Open Enrollment; in certain situations, such as an SEP due to the birth of a child, an SEP during Open Enrollment can allow qualifying consumers’ coverage to start sooner than it would have if they had enrolled during Open Enrollment without the SEP.

Events that permit an SEP include:

  • Loss of qualifying health coverage (Note: This SEP does not include loss of coverage due to nonpayment of premiums.)
  • Change in household size
  • Change in primary place of living that results in access to new QHPs
  • Change in eligibility for Marketplace coverage or help paying for coverage
  • Enrollment or plan error
  • Other situations and exceptional circumstances

In most cases, consumer have 60 days from the date of the qualifying event to enroll in coverage. If the consumer is enrolling in Marketplace coverage for the first time, he or she may need to submit documents to prove SEP eligibility. Consumers who are members of a federally recognized Indian tribe or Alaska Native Claims Settlement Act Corporation shareholders can sign up for or change plans once per month throughout the year.

As always, please contact your Total Benefit Solutions health insurance specialists with any questions or concerns at (215)355-2121.