Special Enrollment Periods Flashcards
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Read the first 6 Special Enrollment Periods flashcards as text
A Special Enrollment Period (SEP) is triggered when an individual loses minimum essential coverage. How many days does the person typically have to enroll in a new plan?
Answer: 60 days
Individuals have 60 days before or after the qualifying life event to enroll or change coverage outside of Open Enrollment.
Which of the following is a qualifying life event that triggers a Special Enrollment Period?
Answer: Getting married
Getting married is a qualifying life event that triggers a 60-day SEP, allowing the newly married individual to enroll in or change health coverage.
Having a baby triggers a Special Enrollment Period. The SEP window begins:
Answer: The day of birth and lasts 60 days
The birth of a child triggers a 60-day SEP starting from the date of birth, and coverage can be made retroactive to the birth date.
When is the annual Open Enrollment Period (OEP) for ACA Marketplace individual and family plans?
Answer: November 1 – January 15
The ACA Marketplace Open Enrollment Period runs November 1 through January 15, with coverage starting January 1 for enrollments completed by December 15.
An employee who is newly eligible for employer-sponsored coverage has how many days to enroll?
Answer: 30 days
Under HIPAA portability rules, newly eligible employees have at least 30 days to enroll in an employer-sponsored plan when they first become eligible.
Moving to a new ZIP code or county that changes available plan options triggers a SEP. The enrollee must provide documentation such as:
Answer: Proof of prior address and new address
When claiming a move-based SEP, the Marketplace may require documentation showing the prior and new addresses to verify eligibility.