Employees who experience a qualifying life event may be eligible to enroll or make coverage changes outside of Open Enrollment.
Open Enrollment is a distinct period from SEPs and does not affect eligibility for SEPs. During Open Enrollment, employees can enroll in or waive coverage for the upcoming year.
What is a Special Enrollment Period?
A Special Enrollment Period (SEP) is a window that allows eligible individuals to enroll in or change health coverage outside of Open Enrollment.
Employees have a 60-day window before or after a qualifying life event to enroll in or change their health coverage.
What qualifies for an SEP?
Common qualifying life events include:
Marriage
Birth or adoption of a child
Loss of other health coverage
Permanent move
Moving to a new state (triggers the ability to shop for state-specific plans)
Voluntary cancellation or nonpayment does not qualify as a QLE. Additionally, loss of employer-sponsored or spousal coverage qualifies, with a 60-day window before or after the coverage end date to enroll. The QLE process in Take Command does not update your Marketplace enrollment or report changes to the Marketplace.
How do I use an SEP?
Log in to your account and navigate to the Health Insurance tab.
Select the "Qualifying Life Event" option on your dashboard.
Upload documentation verifying the QLE. Ensure the documentation includes your full name, the plan/carrier name, type of coverage, and the effective start date. Common examples: marriage certificate, birth certificate or hospital record (newborn), loss-of-coverage letter or COBRA election notice, or employer letter for employment-related events.
Select "Shop Insurance Plans" and follow the on-screen instructions to enroll in a plan that fits your updated needs.
Verify and update your personal information, dependents, and plan details to ensure accuracy.
Specific Scenarios
Moving to a New State
Update your address in the portal to view plans available in your new state.
Upload proof of your move (e.g., a utility bill or lease agreement).
Shop for a new plan and complete enrollment.
Adding or Removing Dependents
Use the QLE process to add or remove dependents.
Upload supporting documentation, such as a birth certificate or a note from your carrier.
Update your plan to reflect the correct dependents and verify all details before completing enrollment.
Switching to Medicare or Another Plan
Select the option indicating you already have coverage.
Upload proof of your new plan, ensuring all required details are included.
Update your reimbursement settings to reflect the new plan.
If the 'Qualifying Life Event' button is not visible on your dashboard, this is a backend account configuration issue — contact Customer Experience with your qualifying event type, the date it occurred, and a screenshot of your portal. Do not wait if your 60-day window is approaching.
Key takeaway
Employees who experience a qualifying life event may be eligible to make coverage changes through an SEP.
Missing the 60-day SEP window may require waiting until the next Open Enrollment. Ensure timely documentation to validate your QLE and avoid delays.