SEP stands for Special Enrollment Period. It’s a time outside the Health Insurance Marketplace® annual Open Enrollment Period when you can enroll in health insurance. You can enroll in Medicaid or CHIP at any time but once outside of the OEP, you need a SEP for health insurance.
You must experience one of many Qualifying Life Events (QLEs) to be eligible for a SEP and you must request it within a specific time window before/after the event occurs. The time window will vary depending on the type of SEP (usually 60 days before or 60 days after the event).
A QLE (qualifying life event) is a major change in your circumstances, either planned or unplanned) that can impact your insurance needs to such a degree that existing coverage is no longer suitable. The SEP (special enrollment period) provided due to a QLE gives you the chance to update your information and make appropriate changes to your plan to accommodate the change in circumstances without having to wait until the next Open Enrollment Period.
If you’re not sure whether or not you qualify, this screening tool from HealthCare.gov can help: Find out if you can get health coverage now
Life changes that may qualify for a SEP (such as changes in household or residence, loss of health coverage, or other qualifying changes) are detailed in the drop-down section below. For loss of health coverage, SEP details depend on the type of coverage lost. You may qualify for a SEP if you or anyone in your household lost qualifying health coverage in the past 60 days OR expects to lose coverage in the next 60 days.
If you lost Medicaid or CHIP coverage in the past 90 days, you may qualify for a SEP.
Contact the Marketplace Call Center at 1-800-318-2596 (TTY: 1-855-889-4325)
They’ll ask for information about your situation and see if you qualify for a SEP. If so, they’ll help you apply and enroll in coverage.
If you’re already enrolled in a plan and you get a SEP, you can stay in your current plan (in most cases) or switch plans. In some limited cases, you may qualify for an earlier start date of coverage. NOTE: Remember that you must pay your first premium payment before your coverage starts.
If the Marketplace denies your request for a SEP, you can file an appeal if you disagree with the decision. If your appeal is successful, you can get coverage back to the date your SEP was denied.
More about how to file an appeal
Health Insurance Marketplace® is a registered service mark of the U.S. Department of Health & Human Services.