Qualifying Life Events & Special Enrollment


Apply for Individual Coverage Outside of Enrollment

 

 

If you have a qualifying life event (QLE) you may be eligible for a special enrollment period (SEP) outside of the annual Open Enrollment Period.

 

A Special Enrollment Period is granted when a Qualifying Life Event causes you to lose or change your coverage.

 

You have a 60-day window to apply for individual coverage on the Marketplace or direct with a carrier.

The following list details the basic events you must experience in order to be granted an SEP.

 

Contact an agent at 888-803-5917 for more details on eligibility and applying for coverage.


 

Involuntary Loss of Minimum Essential Coverage

  • Health Plan is discontinued due to insufficient coverage under the ACA
  • Change in full-time employment status
  • Loss of employer coverage due to employment termination OR employer no longer offers coverage
  • Divorce, Legal Separation or Termination of Domestic Partnership or Civil Union
  • Dependent loss of coverage upon turning 26
  • Death of a spouse or parent

 

Gaining/Becoming a Dependent

  • Marriage
  • Domestic Partnership
  • Birth or adoption of child/children
  • Placement for adoption of child/children
  • Gaining guardianship status

 

Other Qualifying Events

  • Gaining citizenship or eligible immigration status
  • Moving to a new state permanently
  • Enrollment errors by HHS or the Marketplace
  • Health Plan violates its contract
  • Change in eligibility for tax credits or cost sharing reductions
  • American Indians can enroll and change health plans once per month
  • Enrolled in non-qualifying employer coverage
  • Return from active military duty
  • Release from incarceration

 

Effective July 11, 2016, the rules for SEPs and QLEs changed according to guidance issued by The Centers for Medicare & Medicaid Services. Moving solely for medical treatment or vacation does not qualify as a Special Enrollment Period for Relocation.

 

Relocation SEP Guidelines

SEP Rules Effective July 2016

  • Permanent move or relocation SEP is 60 days after the permanent move or relocation date.
  • Applicants with a permanent move or relocation within the US must now have had at least one day of “minimum essential coverage” (MEC) in the 60 day period preceding their permanent move or relocation.
  • For the following circumstances, there is no requirement for prior MEC:
    • If the individual’s permanent move or relocation is from another country to the US or from a US territory.
    • If the individual is being released from incarceration.