FAQ: Special Enrollment period (SEP)
A Special Enrollment period (SEP) is a period of time outside of the Open Enrollment period when 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 moving into a new service area, you may qualify for a Special Enrollment period.
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. These include:
- Adoption/foster care
- Loss of coverage because of the following events1
- Losing coverage through your job
- Legal separation or divorce from your spouse
- Death of policy holder
- COBRA expiration
- Losing eligibility for Medicaid or CHIP
- Permanent move into insurer’s network
- You change your permanent residence to the Independence Blue Cross five-county service area
- You become a U.S. citizen
The Special Enrollment period is determined by the type of 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.
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.
When you apply during a Special Enrollment period, 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 order to avoid disruptions to your health care coverage. You can preview the Eligibility Notice, under “Eligibility Notice – Special Enrollment Periods.”
No. Only getting married will qualify you and your partner for a Special Enrollment period.
No. If you were previously covered through your job and you lose that coverage, you may apply during a Special Enrollment period.
Yes, you can apply during a Special Enrollment period if your COBRA benefits expire. Expiration of your COBRA benefits is a qualifying life event.
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 Affordable Care Act (ACA) do not qualify as life events that allow you to enroll during the Special Enrollment period.
You will have to wait for the next Open Enrollment period to apply for a health insurance plan.
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 ACA do not qualify as life events that allow you to enroll during a Special Enrollment period.