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Special Enrollment Period

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What is Special Enrollment Period?

The Special Enrollment events are any time outside the yearly Open Enrollment Period. Open Enrollment is when you can freely sign up for health insurance. You qualify for a Special Enrollment Period Qualifier if you have had certain life events occur. These can include: losing health coverage, moving, getting married, having a baby, or adopting a child.

It is important to note that, depending on your Special Enrollment type, you may have 60 days before, during, or following the event to enroll in a plan. If you miss the Special Enrollment Period, you may have to wait until the Open Enrollment Period to apply.

The exception to the above is Medicaid or the Children’s Health Insurance Program (CHIP). This can be enrolled in whether you qualify for a Special Enrollment Period or not.

Another exception is job-based plans. These must provide a Special Enrollment Period of at least 30 days.

Special Enrollment Qualifier: Life Events

Special Enrollment Period

Special Enrollment Qualifiers

Changes in your household

You may qualify for a Special Enrollment Period if you or anyone in your household has in the past 60 days:

  • Gotten Married. You must pick a plan by the last day of the month and your coverage will start on the first day of the following month.
  • Had a baby, adopted a child, or taken a child in for foster care. Your coverage can start the day that the event occurs even if you enroll in the plan up to 60 days after the life event.
  • Got divorced or legally separated resulting in a loss of health insurance. Note: Divorce or legal separation without losing coverage doesn’t qualify you for a Special Enrollment Period.
  • Loss of life. You will be eligible for a Special Enrollment if someone on your current plan dies and as a result you are no longer eligible for your current health plan.

Changes in residence

Household moves that qualify you for a Special Enrollment Period:

  • Moving to a new home in a new ZIP code or county
  • Moving to the U.S. from a foreign country or United States territory
  • If you are a student, moving to or from the place you attend school
  • If you are a seasonal worker, moving to or from the place you both live and work at
  • Moving to or from a shelter or other transitional housing

Note: Moving for the purpose of medical treatment or vacation does not qualify you for a Special Enrollment Period. You have to prove that you had qualifying healthcare coverage for one or more days during the 60 days before your move occurred. You do not need to provide confirmation if you’re moving from a foreign country or U.S. territory.

Loss of health insurance

You may qualify for a Special Enrollment Period if you or someone in your household lost health coverage in the past 60 days or there is an expectation of losing coverage in the next 60 days.

Coverage losses that may qualify you for a Special Enrollment Period include Losing:

  • A job-based coverage
  • An individual health coverage for a plan or policy you bought yourself
  • Eligibility for Medicaid or CHIP
  • Eligibility for Medicare
  • Coverage through a family member

An employer offering to help with the cost of healthcare coverage

You may qualify for a Special Enrollment if you or someone in your household gained access to an individual coverage HRA or a Qualified Small Employer Health Reimbursement Arrangement (QSEHRA) in the past 60 days or expects to in the next 60 days.

In most cases, you will need to apply for an in individual health insurance plan before your HRA or QSEHRA starts. Contact your employer or check the notice you got from your employer for information regarding when your coverage can start.

Other possible Special Enrollment Qualifiers changes

Other life circumstances that may qualify you for a Special Enrollment Period Include:

  • Gaining membership in a federally recognized tribe or getting status as a Alaska Native Claims Settlement Act (ANCSA) Corporation shareholder
  • Becoming a U.S. citizen
  • When Leaving incarceration
  • Starting or ending service as a AmeriCorps State and National, VISTA, or NCCC member

Note: You may have to prove your claims
When you apply for coverage, you will need to affirm that the information you provided on the application is true. You might be required to provide documents that back your eligibility.

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