If you have heath insurance outside of work….read about recent updates.

There have been updates to the special enrollment period (SEP) for individuals who have insurance through the Health Insurance Marketplace or for those that intend on getting their insurance through the Marketplace.

This information was released by the Centers for Medicare & Medicaid Services (CMS) on May 6, 2016.  There are 6 types of circumstances that have been defined and in most situations these circumstances have even further limitations.

In addition to CMS defining the six circumstances, they implemented some new rules. Please read below .

Permanent Move SEP

In order to qualify for a permanent move SEP, an individual must have minimum essential coverage for one or more days in the 60 days prior to the permanent move, unless the individual was living outside the United States or in a United States territory prior to the permanent move.  This rule will ensure people are not moving for the sole purpose of obtaining health insurance outside of open enrollment.

Incarceration SEP

For individuals who were incarcerated, there have been some changes that will ensure they qualify for an SEP.

Implementation Deadline 

The January 1, 2017 deadline was removed and thereby giving the Marketplace the option of providing an SEP for permanent move, loss of a dependent, or for a person no longer being considered a dependent due to a divorce, legal separation or death.

Does all of this sound confusing?  That is ok!  Contact us, we are here to help you know your options.

(336) 793-1833


Six Circumstances For A Special Enrollment Period

  1. Losing other qualifying coverage

  2. Changes in household size like marriage or birth

  3. Changes in residence, with significant limitations

  4. Changes in eligibility for financial help, with significant limitations

  5. Defined types of errors made by the Marketplace or the insurance company

  6. Other specific cases like moving between Medicaid and the Marketplace or leaving Americorps coverage

For full details regarding these changes, please contact us at (336) 793-1833 or visit CMS.gov


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