Special Enrollment Periods (SEPs) with Jeff Hess

Whats a Special Enrollment Period (SEP)?

Special enrollment periods (SEPs) are typically a small window outside of the annual open enrollment period (OEP) where people can get health insurance. They must have a qualifying event in order to get an SEP. Throughout the years, the qualifying events became stricter. The first year people, who didn’t technically qualify for a SEP, could call Healthcare.gov and please their case, at which point, they’d typically get a SEP. In other words, they used to hand out SEPs more freely. Now, however, they are much stricter. For instance, there are only about six or seven different qualifying events. An example of a qualifying event is loss of qualified coverage with the exception of nonpayment.

Sending proof of change

Before the new restrictions, people used to be able to simply apply for it. Today, when you apply for a SEP, they will ask you for proof with regards to your qualifying event. So if you lost coverage, then you need to get something from your prior insurance company and submit it to Healthcare.gov, who will then verify it with the carrier. Another qualifying event for a SEP is marriage or the addition of a child so proof in these cases would be a marriage or birth certificate. Pictures won’t work. In addition, if you’ve been denied coverage from Medicaid or CHIPs, then you can also apply for a SEP so long as you provide proof of the denials.

Moving is another qualifying event. Unlike before, people don’t automatically qualify for a SEP if they move. They need to show proof that they lost coverage because of the move. This is where it gets tricky. Let’s say, for instance, that, in a family of four, only the mother and kids had health coverage, meaning the dad did not have insurance. If they all moved from one state to another, then only the mother and kids would qualify for a SEP because they’re the only ones who had health insurance prior to the move. The father would have to wait for the open enrollment period or consider purchasing unqualified health coverage for himself. As for the mother and kids, who qualify for a SEP, they must show proof of their move, as well as proof of income to show whether or not they’re receiving advanced tax credits towards their premium.

60-day window

Again, special enrollment periods got a lot stricter. People have to be organized about it. So when they get the information from the carrier from whom they just lost coverage, they need to be looking in the mail and documenting letters from the carrier as proof. The insurance company could have the certificate of creditable coverage that they will need in order to get new coverage. If they don’t have proof and they miss the sixty-day window from the time that the event occurred, then they’re out of luck.

When somebody loses their coverage at the end of March, then they have almost all of April and May to apply for new coverage. You get sixty days (not necessarily two months), to do the application. If you wait till June enroll, you’re out of luck getting a qualified health plan. However, there are other options, such as short term medical, as well as fixed indemnity products, that can help cover you until the next open enrollment period.

Since insurance is often times overwhelmingly confusing, we want to shed light on this industry by answering YOUR questions.  So if you have any questions or concerns, comment below and your question may be the topic of our next video!

Get affordable health insurance quotes by clicking here.

For immediate assistance, call us toll-free at (844) 410-1320!

Leave a comment

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