SEP Reason Accepted Documents Coverage Start Date ...
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You have to wait until the next OEP, which is usually early November through mid December. The government sets Open Enrollment Period (OEP) dates. You can enroll in a short-term plan up to 180 days at a time, but after your short-term coverage ends, you must wait 60 days before enrolling in another short-term plan. This will help cover your medical costs, but these plans aren’t qualified health plans under the ACA. You may have to pay a tax penalty. Special Enrollment Period (SEP) HOW DO I QUALIFY FOR AN SEP? You need to have a qualifying life event that changes your needs. If your event counts, you will have a period of 60 days after your qualifying event occurs to enroll in a plan. Here are some examples of qualifying events: • Getting married • Having or adopting a child or the placement of a foster child • Moving to a new area that offers different health plan options • Losing health coverage due to job loss, divorce, involuntary loss of eligibility for Medicaid or Children’s Health Insurance Program (CHIP), COBRA coverage ending, termination of employer contributions to your health plan, no longer meeting the requirements of the Affordable Care Act (ACA) for being a qualified health plan • A change in income or household status for people who aleady have a qualified plan can be a qualifying event, because it may change how much help you can get paying for your plan WHY DOESN’T MY BIG EVENT COUNT? Not every big event is a qualifying life event. It’s not considered a qualified event if you: • Lose your plan because you didn’t pay your premiums • Choose to quit other healthcare coverage • Lose coverage that’s not minimum essential coverage, like a short-term plan You or a dependent has become eligible (or ineligible) for a premium tax credit, or there’s a change to your cost-sharing amount. You got wrong information about your plan or your need for a plan from an officer, employee or agent of the federal Marketplace.* You enrolled in a plan that violated its contract with you. * You or your dependent gained citizenship, na- tional or lawfully present status. Documentation from the federal Marketplace Letter from the federal Marketplace on letterhead Letter from insurer on letterhead Naturalization certificate or certificate of citizenship If your qualifying event occurs on or before the 15th of the month, your coverage will start the 1st of the following month. Anytime after the 15th, you’ll have to wait a month (until the 1st of the next following month) before your coverage kicks in. SEP Reason Accepted Documents Coverage Start Date (Effective Date) Date of Your Qualifying Event May 14 May 17 Your Start Date June 1 July 1 You’re adding a dependent because of a birth, adoption of a child, placement of a child pending legal adoption or placement of a child into foster care. • Hospital-issued birth certificate • Birth certificate or application for a birth certificate • Birth certificate that includes the name of the adopting parent • Social Security number (SSN) or application for SSN • Foreign birth record • Military record showing the child’s date and place of birth • Religious record showing the child’s date and place of birth • Letter or other document from the health insurance company, like an Explanation of Benefits, showing services related to birth or post-birth • A certificate with the date of adoption • Court documents showing placement for adoption • A notarized statement by the adoption agency that adoption proceedings have been initiated and that the child has been placed for adoption • Foster care papers signed by a government or court official that show the name of the person who was placed in foster care and the date of the placement OR A notarized letter from the policyholder’s lawyer that defines the parties involved and terms of the appointment. The document should include a statement indicating that the policyholder is responsible for the medical care of the child. Three options: 1. Elect coverage with an effective date on the actual date of the qualifying event (date of birth, adoption or placement of child) 2. Effective date is the 1st of the month following the date of the qualifying event 3. The regular effective dates SEP Reason Accepted Documents Coverage Start Date (Effective Date) Baby Born Submit Your Application May 22 May 22 May 14 May 17 Option 1 Option 2 Option 3 Your Start Date May 9 June 1 June 1 July 1 Here are examples to help explain each option. May 9 PAGE 3 Every year, the government sets dates for an Open Enrollment Period (OEP) for buying individual health insurance. Once the OEP is over, you must qualify for an SEP if you want to make a change to your plan or enroll in a new one. Health Alliance requires that you provide documentation to verify your SEP. WHEN DOES MY COVERAGE START? Your coverage start date (or effective date) for a Health Alliance Individual Plan depends on your qualifying life event. The charts on the following pages will explain for each event, but the standard effective dates are as follows: If enrollment is requested between the 1st and 15th of the month, then the effective date is the first day of the following month. If the event falls between the 16th and last day of the month, the effective date will be the first day of the second month following the request. HOW DO I ENROLL? • Get started, visit HealthAlliance.org/Enroll. • Get a quote and enroll online. • Call 1-877-686-1168 (TTY 711). • Use the fillable application and email it to [email protected]. • Provide the required documentation to verify your qualifying event. • Stop by our office at 3301 Fields South Drive, #105, in Champaign. • Call or visit your local insurance agent. If you have questions about SEPs or your situation, give us a call at 1-877-686-1168 or stop by our office at 3301 Fields South Drive, #105, in Champaign. Marketplace members should call 1-800-318-2596. Here are two examples to help explain this. * Please note, your plan effective date is based on federal guidelines and the guidelines of the Health Insurance Marketplace. Your SEP will not exceed 60 days. PAGE 2 WHAT CAN I DO IF I DON’T QUALIFY? • • PAGE 3 TM COVERAGE EFFECTIVE DATES
Transcript of SEP Reason Accepted Documents Coverage Start Date ...
You have to wait until the next OEP, which is usually early November through mid December. The government sets Open Enrollment Period (OEP) dates.
You can enroll in a short-term plan up to 180 days at a time, but after your short-term coverage ends, you must wait 60 days before enrolling in another short-term plan. This will help cover your medical costs, but these plans aren’t qualified health plans under the ACA. You may have to pay a tax penalty.
Special Enrollment Period (SEP)HOW DO I QUALIFY FOR AN SEP?You need to have a qualifying life event that changes your needs. If your event counts, you will have a period of 60 days after your qualifying event occurs to enroll in a plan.
Here are some examples of qualifying events:
• Getting married
• Having or adopting a child or the placement of a foster child
• Moving to a new area that offers different health plan options
• Losing health coverage due to job loss, divorce, involuntary loss of eligibility for Medicaid or Children’s Health Insurance Program (CHIP), COBRA coverage ending, termination of employer contributions to your health plan, no longer meeting the requirements of the Affordable Care Act (ACA) for being a qualified health plan
• A change in income or household status for people who aleady have a qualified plan can be a qualifying event, because it may change how much help you can get paying for your plan
WHY DOESN’T MY BIG EVENT COUNT?Not every big event is a qualifying life event. It’s not considered a qualified event if you:
• Lose your plan because you didn’t pay your premiums
• Choose to quit other healthcare coverage
• Lose coverage that’s not minimum essential coverage, like a short-term plan
You or a dependent has become eligible (or ineligible) for a premium tax credit, or there’s a change to your cost-sharing amount.
You got wronginformation about your plan or your need for a plan from an officer, employee or agent of the federal Marketplace.*
You enrolled in a plan that violated its contract with you. *
You or your dependent gained citizenship, na-tional or lawfully present status.
Documentation from the federal Marketplace
Letter from the federal Marketplace onletterhead
Letter from insureron letterhead
Naturalization certificate or certificate of citizenship
If your qualifying event occurs on or before the 15th of the month, your coverage will start the 1st of the following month. Anytime after the 15th, you’ll have to wait a month (until the 1st of the next following month) before your coverage kicks in.
SEP Reason Accepted Documents Coverage Start Date (Effective Date)
Date of Your Qualifying Event
May 14
May 17
Your Start Date
June 1
July 1
You’re adding a dependent because of a birth, adoption of a child, placement of a child pending legal adoption or placement of a child into foster care.
• Hospital-issued birth certificate • Birth certificate or application for a birth certificate • Birth certificate that includes the name of the adopting parent• Social Security number (SSN) or application for SSN• Foreign birth record • Military record showing the child’s date and place of birth • Religious record showing the child’s date and place of birth• Letter or other
document from the health insurance company, like an Explanation of Benefits, showing services related to birth or post-birth
• A certificate with the date of adoption• Court documents showing placement for adoption • A notarized statement by the adoption agency that adoption proceedings have been initiated and that the child has been placed for adoption• Foster care papers signed by a government or court official that show the name of the person who was placed in foster care and the date of the placement ORA notarized letter from the policyholder’s lawyer that defines the parties involved and terms of the appointment. The document should include a statement indicating that the policyholder is responsible for the medical care ofthe child.
Three options:
1. Elect coverage with an effective date on the actual date of the qualifying event (date of birth, adoption or placement of child)
2. Effective date is the 1st of the month following the date
of the qualifying event
3. The regular effective dates
SEP Reason Accepted Documents Coverage Start Date (Effective Date)
Baby Born Submit Your Application
May 22
May 22
May 14
May 17
Option 1
Option 2
Option 3
Your Start Date
May 9
June 1
June 1
July 1
Here are examples to help explain each option.
May 9
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Every year, the government sets dates for an Open Enrollment Period (OEP) for buying individual health insurance. Once the OEP is over, you must qualify for an SEP if you want to make a change to your plan or enroll in a new one. Health Alliance requires that you provide documentation to verify your SEP. WHEN DOES MY COVERAGE START?
Your coverage start date (or effective date) for a Health Alliance Individual Plan depends on your qualifying life event. The charts on the following pages will explain for each event, but the standard effective dates are as follows: If enrollment is requested between the 1st and 15th of the month, then the effective date is the first day of the following month. If the event falls between the 16th and last day of the month, the effective date will be the first day of the second month following the request.
HOW DO I ENROLL? • Get started, visit HealthAlliance.org/Enroll.
• Get a quote and enroll online.
• Call 1-877-686-1168 (TTY 711).
• Use the fillable application and email it to [email protected].
• Provide the required documentation to verify your qualifying event.
• Stop by our office at 3301 Fields South Drive, #105, in Champaign.
• Call or visit your local insurance agent.
If you have questions about SEPs or your situation, give us a call at 1-877-686-1168 or stop by our office at 3301 Fields South Drive, #105, in Champaign.Marketplace members should call 1-800-318-2596.
Here are two examples to help explain this.
* Please note, your plan effective date is based on federal guidelines and the guidelines of the Health Insurance Marketplace. Your SEP will not exceed 60 days.
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WHAT CAN I DO IF I DON’T QUALIFY?•
•
PAGE 3
TM
COVERAGE EFFECTIVE DATES
If you gain adependent undera court order.
You or a dependent moved to a new service area with different planofferings andpossibly a newnetwork of doctors.
You’re adding adependent because of marriage or a civil-union partnership. You may enroll yourself and/or your new spouse (and any other dependents) not enrolled on a plan.
You and/or your dependents lose coverage not by choice.
This may include:
• Losing your job
• Not working enough hours to stay on your employer’s plan
• Your employer stops paying for your plan
• Your plan doesn’t cover the minimum essential coverage (MEC) as required by the ACA
You experience a loss of a dependent or dependent status through divorce or legal separation.
Court documentsshowing court-ordereddependent coverage
Documentation must showall three of the following:1. Date of the move from another state or country2. Proof of residence in another state or country from ONE of the following:• Driver’s license• State ID• Utility bill• Rental, lease or mortgage agreement• Mortgage or rental payment receipt • USPS “change of address” receipt (with old/new address and effective date)• Homeowner, renter or automobile insurance policy• Government tax documents• Car registration• Official school documents, including school enrollment, ID cards, report cards or housing documentation • Phone bill showing new address• Mail from government agency, like Social Security statement, or a notice from TANF or SNAP agency • Bank statement • Pay stub • Letter from current or future employer• Voter registration card • Moving company contract or receipt showing new address • A letter/statement from a friend, family member or roommate who resides at the new address. This letter must prove their own residency by including one of the documents above. • Document from the Department of Corrections, jail or prison indicating recent release or parole• Letter or statement from homeless shelter
3. Either a record of MEC for one or more days during the 60 calendar days before the permanent move or a record that the applicant has lived outside the U.S. (or a U.S. territory) at the time of the permanent move
• Marriage license or certificate
• An official public record of the marriage
• Affidavit or statement signed by marriage officiator
• Affidavit or statement signed by marriage witness
• A religious document that recognizes marriage
• Domestic partnership certificate (WA only)
• Civil union certificate
• Letter from employer on employer letterheadexplaining why coverage was terminated(If above cannot be provided, official documentation from unemployment along with reason for termination)
• Carrier coverage cancellation notice or certificate of creditable coverage • COBRA benefit letter on letterhead
• “Termination of Coverage” letter from existing/prior insurance company indicating dependent is not an eligible dependent
• A letter from employer confirming loss of contribution
• A letter from employer on company letterhead and signed by an officer/owner of the company indicating reduction in hours and loss of coverage along with pay stubs showing reduction in hours
• Letter from prior insurer or employer with coverage termination date on company letterhead
• Discontinuation notice
• COBRA notice
• State continuation notice
• Certificate of creditable coverage
• COBRA “Termination of Coverage Letter” from insurer (proof of prior healthcare coverage) from existing/prior insurance company
Court-issued divorce decree including date of divorce, judge’s signature and member’s name
Divorce or annulment papers that include the date of endingresponsibility for providing healthcarecoverage
Two options:1. If you complete your application before you move, the effective
date will be the 1st of the month following the date of the move.
2. If the plan is selected after the move, the effective date would be the first day of the second month following the move.
Your effective date is the first day of the following month (after the date of the event).
SEP Reason SEP ReasonAccepted Documents Accepted DocumentsSEP Reason
SEP Reason
Coverage Start Date (Effective Date) Coverage Start Date (Effective Date)Coverage Start Date (Effective Date)
Coverage Start Date (Effective Date)
Accepted Documents
Accepted Documents
Dateof Event
Submit Your Application
June 5
Submit Your Application
June 16
July 14
July 14
July 14 (on or before the 15th)
July 17 July 17
July 17 (after the 15th)
Option 1
Three options:* Elect coverage effective on the date of court order. * 1st of the month following the date of the qualifying event. * If enrollment is requested between the 1st and 15th of the month, the effective date is the first day of the following month. If the event falls between the 16th and last day of the month, the effective date will be the first day of the second month following the request.
Option 3
July 1
Your Start Date
Your Start Date
June 5
August 1
August 1
August 1
September September 1
September 1
Here are examples to help explain two of these optionsHere are examples to help explain.
Here are examples to help explain.
June 5
Submit YourApplication
Event
May 21May 17
YourStart Date
June 1
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Here is an example to help explain.
For applications submitted before the qualifying event, the effective date is the first of the month following the qualifying event. For applications submitted after the event, the effective date would be the first day of the second month following the qualifying event.
Your Qualifying
Event
July 14
Your Start Date
August 1
September 1
Here are examples to help explain.
July 17
For applications submitted before the qualifying event, the effective date is the 1st of the month following the qualifying event. For applications submitted after the event, the effective date would be the first day of the second month following the qualifying event.
If you experience loss of thepolicyholder through death.
Death certificate
Public notice of death
Obituary
SEP Reason Coverage Start Date (Effective Date)Accepted Documents
Submit Your Application
July 14
July 17
Your Start Date
August 1
September 1
Here are examples to help explain.
Two options:1. First of the month following the date of the qualifying event or other regular effective date at the request of the member.2. If enrollment is requested between the 1st and 15th of the month, then the effective date is the first day of the following month. If the event falls between the 16th and last day of the month, the effective date will be the first day of the second following month.
Option 2
July 7
Dateof Event
Option 1
Option 2
July 12 August 1
Submit Your
Application
July 12
July 23
Dateof Event
July 16
Qualifying Event
Submit Your Application Your Start Date
July 16
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