CES Special Enrollment Periods 2 — Questions and Answers
Question 1: An individual who loses employer-sponsored coverage due to job loss may use a Marketplace SEP. The SEP is triggered:
- Only after COBRA coverage expires
- When employer coverage is lost regardless of COBRA eligibility (Correct answer)
- Only if COBRA is declined within 60 days
- Six months before the anticipated job loss
Correct 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.
Question 2: A person gaining Medicaid eligibility triggers which type of enrollment opportunity?
- Open Enrollment Period only
- A Marketplace SEP with 60 days to enroll
- Immediate enrollment in Medicaid with no waiting period (Correct answer)
- An employer plan SEP only
Correct 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.
Question 3: Under HIPAA, a special enrollment right for an employee who gains a new dependent through adoption must be exercised within:
- 30 days of the adoption placement (Correct answer)
- 60 days of the adoption placement
- 30 days of finalization of adoption
- 90 days of adoption placement
Correct 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.
Question 4: Which of the following would NOT typically qualify for a Marketplace Special Enrollment Period?
- Losing coverage because you aged off a parent's plan at 26
- Voluntarily dropping an existing health plan (Correct answer)
- Becoming a U.S. citizen or lawfully present resident
- Leaving incarceration
Correct 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.
Question 5: American Indians and Alaska Natives who are members of a federally recognized tribe have a special Marketplace enrollment right that allows them to enroll:
- Once per year only
- Any month of the year (Correct answer)
- Only during the annual Open Enrollment Period
- Only when losing Indian Health Service coverage
Correct 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.
Question 6: When an employer changes the annual open enrollment period, employees who didn't previously elect coverage may:
- Enroll at any time during the year
- Enroll only if they qualify for a SEP
- Enroll during the new enrollment period even without a life event (Correct answer)
- Wait until the following plan year
Correct 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.
CES Special Enrollment Periods 2
An individual who loses employer-sponsored coverage due to job loss may use a Marketplace SEP.
The SEP is triggered: