March 29, 2017

Off-Exchange SEP Process Updates

There have been a few updates to the way we process individual Special Enrollment Period (SEP) applications. Here’s a quick summary; see the updated SEP Document Guide for details.

Update Summary

• Please don’t use the “Date of Event” field on the application to enter the desired effective date (Page 1).
• Reminder: Short-term/temp policies don’t qualify as minimum essential coverage (MEC), so the loss of such coverage does not allow for special enrollment (Page 2).
• The effective date for a new child (and family members) is the date of birth, adoption or placement (Page 7).
• The effective date for court-ordered dependent coverage is the date of the court order (Page 7).
• For those enrolling due to a permanent move (Page 10), documents must show all of the following:
  1. Date of move
  2. Proof of residence
  3. Record of MEC prior to move
• For policies that expire on a date other than Dec. 31, an accepted document is a letter from the carrier that the plan is Grandfathered or Grandmothered (Page 11).