Understanding SEP Enrollment Eligibility

SEP Enrollment Eligibility

Uninsured Nevadans are looking for ways to enroll in new medical plans mid-year. With new Affordable Care Act mandates, you may qualify for SEP enrollment eligibility, allowing you and your family to sign up for insurance outside of Open Enrollment. Open Enrollment for the 2015 plan year begins on November 15, 2014.

Therefore, individuals may change or enroll in a new Qualified Health Plan outside of the annual open enrollment period. These Special Enrollment Periods need to be accompanied by a Qualified Life Event as defined by Nevada’s Division of Insurance. In addition, a Qualifying Life Event removes a 90 day waiting period.

Some of these Qualifying Life Events include:

  • Gaining as well as becoming a dependent
  • Gaining status as a citizen, national, or lawfully present individual
  • Loss of minimum essential coverage (e.g., loss of Medicaid eligibility, termination of a Qualified Health Plan), except if enrollment is terminated based on failure to pay premiums
  • Loss of affordable employer-sponsored coverage
  • Determining that an individual is newly eligible or ineligible for premium tax credits
  • Change in eligibility for cost-sharing reductions
  • A permanent move to another area where different Qualified Health Plans are available
  • Other exceptional circumstances identified by the Marketplace

The deadline to enroll in a traditional unsubsidized policy with a Qualifying Life Event is the final day of the calendar month, prior to the effective date.

Subsidized health insurance policies include the elongated application, a special 6-page Qualifying Life Event questionnaire, and a more restricted submission deadline date. NV Health Link’s deadline for a SEP enrollment eligibility is on the 15th of the month prior to the effective date.

NV Health Link is currently processing over 6,000 subsidized applications with effective dates outside of 2014’s Open Enrollment. In addition, the state board is working with Nevada’s state exchange to finalize these SEP enrollments.

If you would like a full listing of Nevada’s Qualifying Life Events please contact us. We will assist you with your insurance eligibility.

P: (775) 828-1216

F: (775) 828-1277