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What is a SEP (Special Enrollment Period) and do I qualify for it?

Jul 19, 2019 (0) comment , , ,

Typically, your life goes through many changes. And generally when it does, so can your medical health insurance. Enter the Special Enrollment Period (SEP), or a interval when you’ll be able to apply for brand new medical health insurance because of what’s often called a “Qualifying Life Event” (QLE). Getting married, welcoming a brand new child, losing a job, or moving to a brand new state all launch an SEP. And this implies you’ll be able to look for for brand spanking new coverage that best suits where you might be in your life right now.

What precisely are Special Enrollment Periods?

In the event you qualify for a Special Enrollment Period (SEP), you may change plans or discover a new plan on the Market outside of the annual Open Enrollment Period for the upcoming year. There are three common classes of qualifying life events that can trigger a Special Enrollment Period: Loss of medical insurance, changes in your family, and changes in residence.

It’s additionally vital to note, you may enroll in Medicaid or the Children’s Health Insurance Program (CHIP) any time in the year, whether or not you qualify for a Special Enrollment Period or not.

Wondering if you qualify for a Special Enrollment Period? You’ll be able to use this handy SEP tool to find out if you qualify or you may reach out to one of our independent insurance agents (954) 674-1444.

How long is a  Special Enrollment Period for?

You will have 60 days following the Qualifying Life Event (QLE) to enroll in a brand new Marketplace plan. The clock begins the day you welcome a brand new child into the world, lose your job, transfer to a brand new state, or get married.

When you miss your SEP, you’ll have to wait to enroll in medical insurance till the subsequent year’s Open Enrollment. Beginning on November 1st – December 15th, in Florida.

What are qualifying life events for the SEP?

Life events that frequently qualify a person for a Special Enrollment Period fall into three basic classes, plus uncommon circumstances:

Loss of medical insurance

You would possibly qualify for a Special Enrollment Period if yourself, a partner, or father or mother lose your current medical insurance. For those who lose their job, and their job-provided plan, you’ll probably qualify for a SEP. For those who graduate and your student medical insurance plan via your college ends, it’s probable you’ll qualify, too. Losing your Medicare, Medicaid or CHIP eligibility may also qualify you for a SEP. And for those who’re about to turn 26 and roll off of your father or mother’s medical insurance plan, it’s possible you’ll qualify for an SEP, too.

You will not qualify for a Special Enrollment Period on account of loss-of-coverage for not paying your monthly premium. Couple of good suggestions is to add a reminder to your cellphone, write it down in your calendar, or setup recurring payments to help make sure you stay insured.

Changes in your household

If the number of folks in your family has changed, that may imply you’re now eligible for a SEP. So should you get married or enter into a domestic partnership, you would be SEP-eligible. And should you get divorced or legally separated, you may also be SEP-eligible. However changes in marital status aren’t the only qualifiers. In the event you adopt a child, you may also now be SEP eligible. A SEP will be triggered by a change in your foster care placement. The same goes for aging out of the foster care system. You may additionally qualify for a SEP should you a member of the family pass away.

A Special Enrollment Period may additionally start should you become another person’s dependent. This is applicable because of marriage or a courtroom order. One of the two spouses will need to have had qualifying medical health insurance for no less than 60 days before the wedding to qualify for an SEP.

You’ll want to offer documentation should you apply for a SEP due to a change-of-household. To get coverage, you’ll need to show your Qualifying Life Event. Maintain any marriage licenses, birth certificates, or courtroom orders on hand to make sure you have all the things you need to apply with.

Changes in residence

Lastly, you may additionally qualify for a Special Enrollment Period if you have a change in the place you reside. A ZIP code or county change may set off a SEP, whether you’re moving inside the same state or out-of-state. A student moving to or from the place you attended school would possibly qualify for one. Seasonal staff shifting to or from the place you each reside and work would possibly make you eligible for a SEP too. And in the event you’re moving out of a shelter or different transitional housing, you would possibly qualify, too.

For those who’ve moved and had qualifying medical health insurance for at the least one of the 60 days preceding your move, you possibly can apply for a Special Enrollment Period. (This will not apply in the event you have been residing in a foreign country, in a U.S. territory, or in the event you’re a member of a federally acknowledged tribe or an Alaska native, and couldn’t get coverage in the place you had been 60 days before your move.) Moving someplace just for medical treatment or a trip won’t qualify you for a Special Enrollment Period.

Distinctive circumstances

Outside of this, the other things that would count as a qualifying life event that may set off a Special Enrollment Period are changes in your earnings that have an effect on the coverage you qualify for, gaining membership in a federally acknowledged tribe or standing as an Alaska Native Claims Settlement Act (ANCSA) Company shareholder, becoming a U.S. citizen, leaving incarceration (jail), and AmeriCorps members starting or ending their service.

There are additionally some types of extra distinctive circumstances that may qualify you for a Special Enrollment Period. These distinctive circumstances include pure disasters or experiencing domestic violence. You’ll be able to learn more about these additional circumstances at by contacting the crew at El Mag Insurance.

How do I discover if I’m eligible for a SEP?

Should you assume you may be eligible for a Special Enrollment Period due to a qualifying life event, you should utilize this screener tool. This will let you recognize (within minutes) if you qualify. Then if you’re eligible, you can begin evaluating medical insurance plans immediately. Please keep in mind that you will have a 60 day window to enroll in a medical insurance plan (if you don’t enroll immediately).

How do I enroll during a Special Enrollment Period in 2019?

To apply for a medical health insurance plan throughout a Special Enrollment Period in 2019, it’s essential to first confirm that you have a Qualifying Life Event. Then, you may apply for medical health insurance with one of our independent insurance agents either online or over the telephone. The El Magazine Insurance team is well-trained that help you assess your Special Enrollment eligibility. We are able to also examine your Marketplace plan options and get you enrolled in a plan that best serves your health and monetary needs.

Do I have to submit paperwork to substantiate my qualifying life event?

When you’re enrolling in a medical insurance plan during a Special Enrollment Period, there are just a few further steps to do. Unlike Open Enrollment, the federal government and your insurance company will want documentation to confirm a QLE. You can expect to receive an “Eligibility Results Notice” that details the kind of paperwork needed to finalize your enrollment.

You’ll need documentation that clearly states when the QLE came about. For instance, in the event you’re moving, you possibly can provide bills, leases, or a letter from your previous insurance company. When you lose your insurance coverage due to job loss, you can present a letter from your former employer. With marriages and the birth or adoption of kids, you need to present documents such as birth certificates, marriage licenses, and adoption papers.

When does my coverage begin after a Special Enrollment Period?

You have got 30 days after you decide on your plan to submit the requested paperwork. When you get your SEP verification, you may make the first payment on your medical health insurance premium.
Coverage begins the next month after you enroll in a medical health insurance plan. So, if you happen to enroll in a plan on July 15th, your protection will start on August 1st.

Additionally remember that QLEs related to welcoming a brand new baby, whether or not by means of childbirth or adoption, begin with that little one’s delivery or day of adoption. Consequently, if you complete your insurance application inside the 60-day window of the SEP, as soon as your first premium is paid and the coverage is effective, it should additionally instantly retroactively cover the dates preceding it. That ensures that your new addition is covered from the day you welcome them into your family.

Whereas surprising events, such as job loss, occur, many qualifying life events are situations you’ll be able to plan for, such as marriage, the delivery or adoption of a kid, and moving to a different state. To avoid a gap in coverage, start contemplating your medical health insurance choices 90 days before a qualifying life event. That approach allows you to begin the enrollment process on the first day of your 60-day window. This can guarantee you’ll be able to enroll in your new medical health insurance plan as shortly and easily as possible.

What occurs if I miss my Special Enrollment Period?

For those who qualify for a Special Enrollment Period and miss their 60-day mark, you’ll have to wait till the subsequent Open Enrollment to buy medical insurance, unless you have got one other qualifying life event before then. Nonetheless, in case your household revenue is low, you might qualify for Medicaid or the Children’s Health Insurance Program (CHIP). Both programs permit enrollment at any time through the year.

Whereas the Affordable Care Act no longer requires that every one in the US enroll in a medical insurance plan, there’s actually no good reason to go with out medical insurance. And there are programs such as Medicaid and Medicare, which provide medical insurance to low income and senior adults, in addition to their qualifying members of the family. For those who think they’re eligible for a Special Enrollment Period, or want to check out your Medicaid or Medicare options, go to El Mag Insurance for more information.

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