How to Qualify for a Special Enrollment Period for Health Insurance

On June 23, Healthcare.gov began a new process called Special Pre-enrollment Verification.  Their objective is to verify if someone does qualify to change their insurance enrollment outside of the designated open enrollment time frame which starts in November.

If you want to sign up for a plan or change plans outside the open enrollment period, read on to learn how this new program works.

Special Enrollment Qualifying Events

Many events can result in you needing to adjust your health insurance enrollment outside the normal enrollment period. Phase 1 of pre-enrollment verification started for two SEP types in June. These are:

  • Loss of coverage
  • Permanent move (one of the household members had to have qualifying coverage for at least one of the 60 days preceding the date of the move or lived in a foreign country for at least one of the 60 days preceding the move

In August 2017, Phase 2 of the pre-enrollment verification starts for 3 additional SEP types:

  • Marriage
  • Medicaid/CHIP denial
  • Gaining or becoming a dependent through adoption, placement for adoption, placement in foster care, or a child support or other court order

These events can change the insurance options you have available, based on changes such as insurance status (single versus family plans) and the availability of programs in a new state.

How to Get Verified

Below are the steps you need to follow to get verified for a special enrollment period, so you can enroll in a health insurance plan.

Important Deadlines

Why Should This Be a Particular Concern Presently?

As mentioned previously, Healthcare.gov efforts to seek documentation or verification to merit Special Enrollment status is a relatively new thing. If Healthcare.gov determines that you are required to submit such documentation in pursuit of special enrollment, they will notify you.

The most important thing to remember is that you must respond with the documentation within only thirty days of submitting your application.

What’s The Risk Involved If I Choose Not To Provide The Requested Documentation?

The simplest answer would be this:  failure to be enrolled in the health plan you have selected.

Under recent changes, when verification is requested it is required. Without providing the necessary documentation requested, your selected health insurance plan will not be active – carrying implied health, financial, and legal burdens.

So – I Always Only Have Thirty Days To Give Them This Documentation?!

Not quite. Healthcare.gov allows a period of 60 days after the qualifying event (such as divorce, marriage, change of residency, etc.) to make use of the Special Enrollment Period. The time frame of 30 days specifically refers to the time allowed to provide documentation of the qualifying event after choosing a new plan.

If you qualify for an SEP, I urge you to act on it immediately to ensure that you get enrolled in the health plan that you selected and there will be no coverage gaps. Failure to complete the steps mentioned above could leave you without coverage and you’ll have to wait for the next Open Enrollment Period to get health coverage.

  Date posted: Wednesday, July 26th, 2017
Category: Health Insurance



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