Special Enrollment Period Rules


    Before Obamacare was in place, many people didn’t realize there was an enrollment period for health insurance.  While it is important to ensure you sign up for coverage within this three month window (from November 1st -January 31st), there are special circumstances that would allow you to sign up for health insurance outside of open enrollment, some of which have new rules.  Check out what qualifies for Special Enrollment Period, or SEP:

  • Permanently Moving:  There has been an update to this exception.  It was found that some enrollees were moving, JUST TO QUALIFY FOR INSURANCE!  The new guideline is that in order to qualify for the permanent move SEP, the enrollee must have had minimum essential coverage (MEC) for at least one day within the 60 days prior to requesting new coverage under the SEP.  In other words, if you don’t have coverage and decide to move just to qualify for special enrollment, don’t do it, you no longer qualify.  If you lived outside of the United States or in a United Territory and move to the U.S., you do qualify for the permanent move SEP.
  • Incarcerated:  If you were incarcerated, you were not required to maintain MEC.  Having been released from custody, you now qualify for SEP.  Just make sure you get enrolled within 60 days, that’s the time frame you have before you lose the SEP qualification.
  • Involuntary Loss of Coverage:  If you lost your coverage due to the loss of your job, aging off of your parent’s policy, losing Medi-Cal eligibility, COBRA ended, divorce, etc., you qualify for SEP.  This is not to be confused with losing coverage due to premiums not being paid, as this situation DOES NOT qualify for SEP because it is not considered to be an involuntary loss of coverage.    
  • Household/Status Changes :  If you got married, had or adopted a child, returned from active duty military service or gained citizenship or lawful presence, you qualify for SEP.   
  • Other Qualifying Events:  There are several other situations in which you may qualify for SEP.  If you are newly eligible or ineligible for tax credits or cost sharing reductions due to income change, error occurred (by an agent, enrollment counselor, Service Center representative or technical system error) by which affected your policy, your health plan violated its contract, hardship as recognized with certificate from Health and Human Services, you are a victim or domestic abuse or spousal abandonment, are require to provide coverage for a child by court order, or if your health care provider left your network while you were receiving care for specific conditions.    

    It is important to know that if any of these situation apply to you, you have 60 days to get enrolled for SEP.  If you miss this very specific time frame, you will have to apply for coverage once open enrollment starts and will have coverage for the following year.  If you think you qualify for SEP, give us a call at (760) 245-2561, we’re happy to help you get signed up.  For more information on Obamacare and FAQs, click hereDon't forget, the open enrollment period for coverage in 2017 will be November 1, 2016 - January 31, 2017.  Mark your calendar!      

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