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Webinar: Special Enrollment Periods


In this webinar presented on February 9, 2017, Shelby Gonzales, Senior Health Policy Analyst, and Halley Cloud, Heath Outreach Manager, discuss updates and changes to the circumstances that trigger a special enrollment period and the timing of coverage effective dates for different triggering events.

Please Note: Changes that the Department of Health and Human Services proposed in special enrollment periods and the dates for the upcoming open enrollment period for 2018 coverage have been finalized and will become effective on June 19, 2017. For more information, see Update on Changes to SEPs Effective June 19, 2017

Presentation Slides

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Enrollment Periods

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Open enrollment

Special enrollment periods

  • Coverage effective dates

 

Qualifying Events That Trigger an SEP

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Loss of other qualifying coverage (video section, slides):

  • Loss of minimum essential coverage
  • Loss of pregnancy-related or medically needy Medicaid
  • Expiration of non-calendar year plan

Changes in household size (video section, slides):

  • Marriage
  • Birth, adoption, or placement for foster care

Changes in primary place of living (video section, slides):

  • Permanent move

Changes in eligibility for financial help (video section, slides):

  • Moving out of the Medicaid coverage gap
  • Current employer plan no longer considered qualifying employer coverage
  • Newly becoming lawfully present
  • Release from incarceration
  • Status as American Indian or Alaska Native
  • Newly eligible or ineligible for premium tax credits
  • Change in cost-sharing reduction eligibility

Enrollment or plan error (video section, slides):

  • Error, misconduct or inaction by entity aiding in enrollment
  • Plan or benefit display error
  • Health plan violation

Other qualifying changes (video section, slides):

  • Being determined ineligible for Medicaid or CHIP
  • Resolving a data-matching issue
  • Survivors of domestic violence or spousal abandonment
  • Exceptional circumstances

 

Events That Do NOT Trigger an SEP

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Common events that do not trigger an SEP

 

Process for Accessing SEPs

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Reporting changes in Healthcare.gov

Accessing an SEP

SEP confirmation process

Pre-enrollment verification pilot program

Resources:

 

Q&A

 


Additional Resources

SEP Reference Chart | View resource

Webinar: Preventing and Resolving Data-Matching Issues | View webinar

Webinar: Immigrant Eligibility for Insurance Affordability Programs | View webinar

Beyond the Basics Webinar Series | View all webinars

Key Facts About Health Reform | View all key facts