Qualify For A Special Enrollment Period? Find Out What Documents You Need

The Affordable Care Act (ACA) changed a lot of things about the way healthcare works in the U.S. One of the changes it made was to create an open enrollment period for everyone shopping for a health insurance policy on the Marketplace. In most cases, you can only enroll in a health insurance plan, or change your plan, during this period, which runs from November 1 to December 15. If you miss open enrollment, then you cannot enroll in a plan, unless you have what is known as a qualifying life event. Experiencing one of these life events opens up a Special Enrollment Period (SEP) for you, meaning that you will be able to sign up for a new plan. Different types of qualifying life events require you to produce different documentation proving your eligibility for a SEP.

Qualifying Life Events

illustration of people moving with a truck and boxes and people carrying boxes.
One of the qualifying life events is moving to another county or state.

A Special Enrollment Period is only available to those who have a qualifying life event, including:

  • Change in residence (moving to different zip code or county)
  • Change in household size (having a baby or adopting a child, getting married, or getting divorced.)
  • Loss of health insurance (losing employment, turning 26 and getting kicked off of a parent’s plan, or death in the family.)
  • Changes in income

The Different Documents Required

If you lose health insurance or need a new plan, and you want to use a Special Enrollment Period to shop for a new plan, you will generally be notified of what documents are needed in your Eligibility Results Notice. You will then have 30 days to submit these documents by mail or by uploading them to healthcare.gov. There are different forms of documentation required depending on the life event.

For change in residence you will need to have moved in the past 60 days and have had health insurance at least one day in the 60 days before your move. To prove this, you will need to submit:

  1. Documents proving that you moved, such as rental agreements, mortgage bills, or utility bills, as well as documents proving your new address and the date of your move.
  2. Documents proving you had insurance prior to your move, such as a letter from an insurance company or employer.

For change in household size you will need:

  1. Legal or government-issued documents of an adoption or a birth certificate
  2. Marriage license or certificate.
  3. Divorce certificate.

For loss of health insurance you must show that you had qualifying health insurance coverage in the past 60 days and that you will be losing coverage in the next 60 days. You will need:

  1. A letter from your insurance company showing termination date.
  2. A loss of health insurance coverage letter from your employer.

For change in income, you will need:

w2 form

  1. Proof of a reduction in income which makes your current plan unaffordable for you, such as a past and current paycheck or W-2 forms.

Special Enrollment Period Coverage

After you submit your documentation and prove that you qualify for a Special Enrollment Period, you can get on the Marketplace and pick a health insurance plan. Coverage for your new plan will either begin the first day of the month after you pick your plan or the first day of the second month after you pick your plan, depending on the qualifying life event. Some types of coverage will be active sooner than others; for example, if you have a baby or adopt a child, coverage is retroactive to the date of the birth or adoption, as long as you pick a plan within 60 days.

Need Help?

If you still have questions on how this all works, contact one of our agents. Our highly trained agents will take the time to talk with you, and will go over all of your documents for you as well as thoroughly explain all of your options. Once you are ready to enroll, they will search through all the plans in your area and find the right plan for you, making sure the plan fits your needs and budget. EZ always provides you with your own personal agent, so there’s never any need to worry about bouncing around from agent to agent or getting hassled by endless sales calls. To get started, enter your zip code in the bar above, or to speak to an agent directly, call 888-350-1890.

About The Author:
Cassandra Love

With over a decade of helpful content experience Cassandra has dedicated her career to making sure people have access to relevant, easy to understand, and valuable information. After realizing a huge knowledge gap Cassandra spent years researching and working with health insurance companies to create accessible guides and articles to walk anyone through every aspect of the insurance process.

Leave a Reply

Your email address will not be published. Required fields are marked *