Taking Advantage of an SEP

The Affordable Care Act allows health insurers to sell qualified healthcare plans (QHP) to all applicants, with exceptions where applicable. The Act, however, states a time window for all open enrollments into the plans, and health plans for 2015 coverage were for open enrollments from November 15 2014 to February 15 2015. Although it may seem that people seeking coverage this year have missed their chance, people who know medical insurance and healthcare revenue cycle management can work around it through special enrollment periods (SEP), wherein they can enroll in a new QHP offered via the ACA Marketplace.

Precursors

The SEP system has a number of qualifying elements that must take place before applicants can be considered. A loss of minimum coverage among employees is highly common; these circumstances include COBRA exhaustion, a QHP losing certification, job transfers or departures that end coverage by company HMO, among others. You can also be marked for SEP if you had a dependent or became one through marriage, birth, foster care, or adoption.

Opportunity

People applying for QHPs via SEP must do so within 60 days after the SEP trigger event took place. On the inverse, their applications can also be processed 60 days before their existing coverage expires.

Missing out on an application window for health insurance coverage is never the end. You can help them find another path.

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