Your Guide to Special Enrollment Periods

Life changes fast—new jobs, new homes, new relationships, and new additions to the family all shape your clients’ health coverage needs. Even though open enrollment has ended, you can continue to support your clients by helping them understand when they may qualify for a special enrollment period (SEP).

SEPs allow clients to sign up for coverage outside the open enrollment window if they’ve experienced a qualifying life event. They’ll typically have 60 days from the event date to choose a plan and submit required documentation.

Common qualifying life events

Here are some of the most common situations that may make your clients eligible for special enrollment:

• Marriage or entering a domestic partnership
• Birth, adoption, or placement of a child
• A binding court order
• Loss of a dependent or dependent status (such as death, divorce, or legal separation)
• Reaching age 26 and aging off a parent’s plan
• Loss of other health coverage due to job changes, divorce, or eligibility shifts
• A move to a different ZIP code or county
• Changes in citizenship or lawful presence
• System or processing errors by state or federal health programs
• Late determination of eligibility

Required documentation

Make sure your clients are prepared to prove their eligibility for a SEP. Once they choose a plan, they’ll be required to submit documents confirming they qualify. Depending on the life event, your clients may need documents such as marriage certificates, birth records, termination letters, or proof of address.

For a full list of qualifying events and documentation guidelines, visit our Special Enrollment page.