Now that the Open Enrollment Period has concluded, you might think it's time to kick back and relax for a few months. Not so fast! There are numerous situations that allow individuals to sign up for health insurance outside of the annual Open Enrollment Period, meaning there are still plenty of opportunities to assist clients. This article, based on the comprehensive guide from CMS titled Understanding Special Enrollment Periods, will help you navigate these critical periods to better serve your clients. You may want to share the guide with clients who are eligible for an SEP.

Special Enrollment Periods: A Primer

SEPs allow individuals to enroll in health coverage or switch plans outside the annual Open Enrollment Period (or during it for an earlier coverage start date). Key triggers for SEPs include changes in primary residence, loss of health insurance, changes in household size, becoming newly eligible for coverage, and certain errors during the enrollment process.

Common SEP Triggers

  1. Change in Primary Place of Living: Moves to a new ZIP code or county, relocation to the U.S. from abroad, or moving for school purposes can qualify clients for a SEP.
  2. Loss of Health Insurance: Loss of employer-sponsored coverage, Medicaid or CHIP, Medicare Part A or an Advantage plan, or individual health coverage due to a decrease in income are common qualifiers.
  3. Changes in Household Size: Events like marriage, childbirth, adoption, foster care, or becoming a dependent due to a court order can trigger a SEP.
  4. Other Qualifying Events: These include becoming a citizen, release from incarceration, gaining status as a member of a federally recognized tribe, enrollment errors, and income changes affecting eligibility for premium tax credits.

Reporting and Enrolling

Clients can apply and enroll in a Marketplace health insurance plan on HealthCare.gov. Be sure that they answer yes, a broker is assisting them with the application, and enter your name and NPN so that you will receive credit and be able to assist with future service needs.

For first-time enrollees, submitting documents to confirm eligibility for an SEP may be necessary. Clients should attest that the information they provide, including facts that qualify them for an SEP, is true​​.

After submitting their application, clients may be asked to send documents to confirm the events that qualify them for a Special Enrollment Period. They have 30 days to send acceptable documents after choosing a plan. Coverage starts when they pick a plan, but they can’t use it until their documents confirm eligibility for the SEP and they make their first premium payment​​.

Your Role as an Insurance Agent

In addition to running quotes and helping clients choose a plan, your guidance is crucial in helping them understand their eligibility for SEPs and the necessary steps to secure coverage. Because an SEP only provides a short enrollment window, it is important that clients don’t drag their feet. While insurance may not be their favorite topic, acting quickly will ensure that they and their family members have the coverage they need.