Special Enrollment Periods Flashcards

An individual who loses employer-sponsored coverage due to job loss may use a Marketplace SEP. The SEP is triggered:

Answer: When employer coverage is lost regardless of COBRA eligibility

Loss of employer coverage—whether or not the person elects COBRA—is a qualifying event that triggers a 60-day Marketplace SEP immediately.

A person gaining Medicaid eligibility triggers which type of enrollment opportunity?

Answer: Immediate enrollment in Medicaid with no waiting period

Medicaid and CHIP enrollment is available year-round with no waiting period, so gaining eligibility allows immediate enrollment at any time.

Under HIPAA, a special enrollment right for an employee who gains a new dependent through adoption must be exercised within:

Answer: 30 days of the adoption placement

HIPAA requires employers to allow special enrollment for adoption within 30 days of the placement, ensuring the child can be immediately added to coverage.

Which of the following would NOT typically qualify for a Marketplace Special Enrollment Period?

Answer: Voluntarily dropping an existing health plan

Voluntarily dropping health coverage is not a qualifying event; SEPs are triggered by involuntary loss of coverage or other life events.

American Indians and Alaska Natives who are members of a federally recognized tribe have a special Marketplace enrollment right that allows them to enroll:

Answer: Any month of the year

Federally recognized American Indians and Alaska Natives can enroll in or change Marketplace plans once per month throughout the year.

When an employer changes the annual open enrollment period, employees who didn't previously elect coverage may:

Answer: Enroll during the new enrollment period even without a life event

Employer plan changes that create a new or extended open enrollment window give all employees the opportunity to elect coverage during that new window.