Individual Special Enrollment Period (SEP) Requirements
Published: 05.29.2024
When submitting Special Enrollment Period (SEP) documentation, carriers require proof that indicates the exact reason of the qualifying event and the event date.Listed below are some common examples.
Loss of Coverage
For loss of coverage, a Certificate of Creditable Coverage (COCC) alone will not suffice as it does not indicate the exact reason for the loss of coverage. If the member is submitting a COCC, additional supporting documentation must be submitted.It must be on company letterhead/official documentation indicating the following:
- Member is no longer employed with the company.
- Member went from full-time to part-time.
- Dependent is no longer eligible because they reached the age limit.
- The primary subscriber is eligible for Medicare; therefore, dependents need to secure their own coverage. A copy of the Medicare card is also needed.
- Employer stopped contributing toward the cost of the member or dependent’s coverage.
- COBRA coverage has been exhausted.
- Non-renewal of group plan; this also includes voluntarily terminating the group plan during the group’s open enrollment period.
- Member lost coverage through their school due to graduating or disenrolling from the college/university.
- Marketplace determination indicating the member is no longer eligible for a subsidy.
- Letter from Medicaid indicating the member is no longer eligible.
Birth of A Child
When adding a dependent due to birth, if the birth certificate is not available, the following documentation can be submitted instead but it must indicate the full name of the child and the date of birth:- Application for a birth certificate.
- Application for a Social Security Number.
- Medical records such as a discharge form.
- Explanation of Benefits showing the dates of service related to the birth of the child.
Moving / Change of Residence
For enrolling due to a move, the following documentation will be required:- Proof of prior residence and current state residence: Some examples include a utility bill for the past 60 days, U.S. Postal Service change of address confirmation letter, mortgage deed, lease or rental agreement, copies of driver’s license, and insurance company documents. If none of these can be provided, a reference letter stating that you are a resident of the state you are moving to and are not temporarily visiting can be provided. This person must also prove their residence by including one of the documents listed above.
- Proof showing date of move: If moving from another country, an arrival/departure record (I-94/I-94A) in a passport that shows date of entry to the U.S., or a passport with an admission stamp showing date of entry into the U.S.
- Proof you had prior coverage from the prior state: Copy of ID card from prior carrier and Certificate of Creditable Coverage. Please note that proof of prior coverage will not be required if the move is from another country.
SEP Chart & Additional Information
For a more detailed list of triggering events and acceptable documentation, please visit the SEP Chart or contact our team directly at individualenroll@savoyassociates.com.Carrier Special Enrollment Period (SEP) Deadlines
The deadline is the last business day prior to the effective date. As far as effective dates are concerned, it depends on the specific carrier. Please refer to the list below.- Aetna - 1st of the month only
- Ambetter/Centene (On-Exchange only) - 1st of the month only
- AmeriHealth NJ – 1st or 15th of the month
- Cigna – 1st of the month only
- Horizon BCBSNJ – 1st or 15th of the month
- Highmark DE and PA – 1st of the month only
- Independence BCBS – 1st of the month only
- Oscar NJ and PA – 1st of the month only
- UnitedHealthcare – 1st of the month only
