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
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.
How do I use an SEP?
Log into your account.
Select the "Qualifying Life Event" option on your dashboard.
Upload documentation verifying the QLE. 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.
Follow the prompts to shop for and select a 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.