Purchasing Coverage Outside of Open Enrollment

Certain qualifying life events allow your clients to obtain healthcare coverage outside of Open Enrollment.

Special Enrollment Periods (SEPs) are granted to those who experience Qualifying Life Events (QLEs) that alter their previous health insurance qualifications.

Below are the different QLE situations that create the unique opportunity to purchase health insurance outside of your employer’s open enrollment period. 

Qualifying Life Events 

For those who qualify through the life events listed below, their SEP lasts 60 days from the time of the life event to apply for coverage. 

Change of Residence

If your clients have a transition in their living situation, they may be eligible for a SEP. Proof of health insurance for at least one day of 60 days prior to their move is required (those moving from a foreign country or U.S. territory are exempt). Acceptable alterations in residence include:

  • Moving to a new county or ZIP code
  • Students transitioning to or from a school location
  • Seasonal working situations that require frequent moving
  • Moving to the U.S. from a foreign country or U.S. territory (or becoming a U.S. citizen)
  • Moving to or from a shelter home
  • Leaving incarceration
  • AmeriCorps VISTA members beginning or ending service

Household Changes

Situations that alter the household dynamic may be considered a QLE. If your client or someone in their household has experienced the following in the past 60 days, they are eligible for an SEP:

  • Got married or divorced. Coverage begins the first day of the following month once you pick a plan.
  • Gave birth, adopted a child, or began foster care. Coverage begins the day of the life event, as long as your client enrolls within 60 days.
  • Death. Your clients are eligible if they unexpectedly lose eligibility for a health plan due to a death of someone on their coverage plan.

Loss of Coverage

Clients who were previously enrolled in healthcare but lost coverage due to the following QLE are eligible to reenroll within the 60-day SEP:

  • Losing individual, job-, or student-based health coverage
  • Aged off a parent’s health plan (at the age of 26)
  • Losing coverage through a family member
  • Losing eligibility for Medicare, Medicaid, or Children’s Health Insurance Program (CHIP)

In addition to these frequent cases for SEP, there are certain exceptional circumstances that are considered QLE. These situations include natural disasters, such as earthquakes, flooding, or hurricanes, and unexpected hospitalizations or incapacitation. 

Contact Canopy Health to Learn More

Canopy Health is proud to serve the Bay Area through an integrated network of alliance partners, including UCSF Health, John Muir Health, and Hill Physicians Medical Group, among others. With thousands of reputable physicians and specialists at dozens of hospitals and care centers across seven counties, Canopy Health has your clients covered. 

Enroll in or Change 2017 Plans — Only With a Special Enrollment Period. (n.d.). Healthcare.gov. Retrieved from https://www.healthcare.gov/coverage-outside-open-enrollment/special-enrollment-period/

Jarchow, B. (2017, April 6). The Coverage Corner: Getting Health Coverage Outside of Open Enrollment. GoHealth. Retrieved from https://www.gohealthinsurance.com/blog/coverage/entry/health-coverage-outside-open-enrollment