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01 Feb What is a Special Enrollment Period (SEP)?

Posted at 12:22h in Enrollment by

If you have questions about enrolling in a health insurance policy outside of the annual Open Enrollment Period, we can help.

 

What is a Special Enrollment Period (SEP)?

A SEP is a 60-day period that allows eligible individuals who experience a qualifying life event to enroll in a health insurance plan that is offered through the Federal Marketplace. The new coverage is for the remainder of the current policy year. A qualifying life event can involve one or more of the following:

 

  • Income at or below 150% of the federal poverty level (new eligibility criteria for 2023)
  • Job loss (and the health insurance from that employer)
  • Marriage
  • Divorce
  • Birth or adoption of a baby
  • Aged-off of your parent’s plan (at 26 years old)
  • Early retirement
  • Moving to a new area
  • Gaining citizenship
  • Error enrolling in coverage during the Open Enrollment Period
  • Lost BadgerCare Plus eligibility

 

To be eligible for a SEP, you must have:

  • Been covered by health insurance during the year you’re seeking new coverage for.
  • Lost that coverage because of a qualifying life event.

 

Why are Special Enrollment Periods important?
SEPs allow people to choose public health insurance plans offered through the Federal Healthcare Marketplace (Exchange), which minimizes the gap in access to healthcare. Looking for insurance? Click here to see the CGHC health plans that are offered through the Federal Marketplace.

 

Examples of Special Enrollment Periods

  • Divorce: Jane and Bob are married with one child, but they have decided to get a divorce. Jane had carried the insurance for the family through her employer-sponsored plan. Their daughter will stay on Jane’s insurance plan. After the divorce, Bob is no longer eligible to remain on Jane’s employer health plan. Bob does not have access to an employer health plan through his work. This makes Bob eligible for a Special Enrollment Period.
  • Job loss and moving out-of-state: Amy has decided to quit her job and move from Michigan to Wisconsin to care for her ailing mother. Since she has lost her Michigan insurance, she is now eligible for a Special Enrollment Period.
  • Having a baby: Katie is pregnant with her first child. While she is pregnant, she is eligible for BadgerCare Plus coverage based on her income. After the baby is born, Katie’s child can remain on BadgerCare Plus, but Katie loses her BadgerCare Plus eligibility following the post-birth care period. This makes Katie eligible for a Special Enrollment Period.

 

If you or someone you know has experienced a qualifying life event and has questions about enrolling in a CGHC health plan, our sales team is here to help. Call us 855.494.2667.

 

 

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