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In this post, we will cover questions you may have about enrolling in a health insurance policy outside of the annual Open Enrollment Period, which is generally between November 1st and December 15th each year. When you enroll outside of the federal open enrollment period, that’s called a Special Enrollment Period.

What is a Special Enrollment Period (SEP)?

A special enrollment period (SEP) is a 60-day period where someone is eligible to enroll in a health insurance plan through the Federal Marketplace due to a qualifying life event. To be eligible for an SEP, you must have had health insurance during the year you’re seeking coverage for and have lost that coverage because of a qualifying life event.  A qualifying life event refers to a major life event you experienced causing you to lose your previous insurance coverage for one or more of the reasons listed below, making you eligible to enroll in new coverage for the remainder of the policy year. A qualifying life event can be one or more of the following:

  • Lost your job (and the health insurance from that employer)
  • Got divorced
  • Had or adopted a baby
  • Aged off of your parent’s plan (at 26 years old)
  • Got married
  • Retiring early
  • Moved to a new area
  • Gained citizenship
  • Errors enrolling in coverage during the Open Enrollment Period
  • Lost BadgerCare Plus eligibility

Why are Special Enrollment Periods important?
Without access to an SEP, many Americans would go without insurance for any number of months in any given year. In recent months, millions of Americans unexpectedly lost their jobs in the midst of COVID-19 and with it, their health insurance coverage. SEPs allow people to choose public health insurance plans through the Federal Healthcare Marketplace, or Healthcare.gov, and enroll in coverage minimizing the gap in access to healthcare. This is especially crucial during the COVID-19 pandemic in order to access testing and treatment services.

3 Real Examples of Special Enrollment Periods

  1. Divorced with children: Jane and Bob are married with one child, Mary. Bob is a stay-at-home father to Mary. In 2014, Jane started her new job and enrolled her family in her employer’s health plan. Jane and Bob decide to get a divorce in March. Their daughter, Mary, will stay on Jane’s insurance plan. Bob, however, is no longer eligible to remain on Jane’s employer health plan. Bob does not have a job and does not have access to an employer health plan, making him eligible for a Special Enrollment Period. He can pick out a health insurance plan that meets his needs through the Federal Marketplace. Bob is eligible for an SEP for 60 days after the divorce. Bob finds the plan with his preferred doctors that works with his budget through CGHC. Bob is now covered with CGHC insurance for the remainder of the year.
  2. Job loss and moving out-of-state: Amy is living in Michigan and has health insurance through the Marketplace. Amy’s mother, Martha, lives in Wisconsin, and her health is declining. In June, Amy decides to quit her job and move to Wisconsin to care for her mother. Since her move, she has lost her Michigan insurance, but is now eligible for a Special Enrollment Period. She enrolls in CGHC coverage for the rest of the year.
  3. Having a baby: Katie is pregnant with her first child. While she is pregnant, she is eligible for BadgerCare Plus coverage based on her income. On April 1, Katie has her baby, Joey. Joey can remain on BadgerCare Plus because he is a young child, but after 60 days, on June 1, Katie loses her BadgerCare Plus eligibility. She becomes eligible for a Special Enrollment Period, and she enrolls in a CGHC plan which covers her through the end of the year.

If you or someone you know has experienced a qualifying life event, you can browse our individual and family plans here. If you have questions regarding our insurance policies, you can make an appointment with a sales team member or call our sales team at 855.494.2667.

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