Do You Qualify? Special Enrollment Period for Individual Health Insurance

Health insurance reform can be confusing. One area that has some people confused is when they qualify for a Special Enrollment Period (SEP). We have received numerous calls asking this question. Here are the answers to when a person qualifies and what events that causes a SEP.

Special Enrollment Period for Individual Health Insurance

Someone may qualify for a Special Enrollment Period if they have lost qualifying health coverage in the last 60 days or is expected to lose coverage in the next 60 days. If they wait to apply for insurance after the 60 of losing coverage, they will have to wait until the next Open Enrollment and their coverage would not start until January 1 of the following year.

The following are the events that could cause a SEP:

Losing an employer sponsored insurance plan due to either being laid off or any other reason for leaving the job
Losing Medicaid, CHIP or Husky coverage
Losing eligible Medicare coverage
Losing health insurance because a family member loses coverage
Change in household size examples:
Getting married (must apply for coverage that would start the 1st of the month following the marriage date
Having a baby, adopting or being placed with a foster child, you have 60 days to get coverage
Losing coverage due to a divorce
Death of the main person covered on a health plan
Change in residence: (Move must be for permanent reasons not a vacation)
Moving to a new home in a different county or state
A student moving to or from the place they attend school
A seasonal worker moving to or from the place they live and work
Moving to or from a shelter or other transitional housing
Change in income that affects the coverage you qualify for
Gaining membership in a federally recognized tribe
Becoming a US citizen
Leaving incarceration (jail or prison)
AmeriCorps members starting or ending their service