Open Enrollment is closed, what is a special enrollment period (SEP)

Most people don’t realize what it means when you hear that the open enrollment for health insurance has ended for 2014.  Because of the new Affordable Care Act (ACA), basically if you are without insurance … in order to get insurance after the open enrollment has ended you will have to have lost coverage “through no fault of your own” and you have to have experienced a Qualifying or “triggering” event.   If one of these events has happened to you, you have 60 days from the date of that event, (including the date of the actual event) to apply for coverage or make a change to an existing plan. Valid documentation will be required to be submitted for all Special Enrollment events.  Depending on which company you go with, your effective date may be the first of the next month after you submit your application, or it may go retro-active back to when your coverage ended.  If it goes retro-active back, you will have to pay the premiums for those months of coverage as well.

See list of events below and select those that apply.

  • An individual and any dependents involuntarily lost minimum essential coverage
  • An individual gained or became a dependent through marriage, civil union, birth, adoption, or placement for adoption, or placement in foster care
  • An individual experienced an error in enrollment
  • An individual adequately demonstrated that the plan or issuer substantially violated a material provision of the contract in which s/he is enrolled
  • An individual became newly eligible or ineligible for advance payments of the premium tax credit or is experiencing a change in eligibility for cost-sharing reductions
  • An individual or enrollee made a permanent move and new coverage is available
  • An individual, who was not previously a citizen, a national, or a lawfully present individual, gains such status
  • An individual released from incarceration
  • An eligible individual and his or her dependent(s) lose employer-sponsored health plan coverage due to voluntary or involuntary termination of employment for reasons other than misconduct, or due to a reduction in work hours
  • An eligible dependent spouse or child loses coverage under an employer-sponsored health plan due to divorce, legal separation or his or her spouse or parent becoming entitled to Medicare or death of his or her spouse or parent
  • An eligible individual loses his or her dependent child status under a parent’s employer-sponsored health plan
  • An American Indian/Alaskan Native, as defined by section 4 of the Indian Health Care Improvement Act

Call to see if you have  a qualifying event and can enroll or if you need help determining which company may be your best option 877-740-8683.  We will be happy to help.

Leave a Reply

Your email address will not be published. Required fields are marked *