Under certain circumstances, individuals may change QHPs outside of the annual open enrollment period. These SEPs are based on certain triggering events* or exceptional circumstances.
Events that permit a SEP include, but are not limited to:
In most cases, SEPs will extend for 60 days from the date of the triggering event. Under certain circumstances, such as the pending loss of minimum essential coverage due to the termination of a QHP, a SEP may begin before the triggering event takes place.
A number of triggering events allow people to enroll in or switch their Marketplace coverage during a SEP outside the annual open enrollment period.
For example, people who lose employer-sponsored insurance, or lose Medicaid coverage because of an increase in income can enroll in a Marketplace plan. Other triggering events include marriage, divorce, and the birth or adoption of a child.
As mentioned in triggering events, a SEP exists for marriage. This means that, if a qualified individual gets married, he or she has the chance to either enroll in a QHP for the first time, or add a spouse to the plan without waiting for the annual open enrollment period.
The Individual Marketplace would need to be notified within 60 days of a marriage for a spouse to be covered. If the 60-day deadline is missed, the spouse cannot enroll until the plan's annual open enrollment period
Another important SEP exists for the birth or adoption of a child.
The effective date of coverage can be the date of the birth or the official date of adoption as long as the Individual Marketplace is notified in a timely manner.
The Individual Marketplace would need to be notified within 60 days of a birth or adoption for dependents to be covered. If the 60-day deadline is missed, the dependents cannot be enrolled until the plan's annual open enrollment period.
Premiums would be pro-rated for the month, based on when the child was added to the policy.
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