Special Enrollment Period
A window outside Open Enrollment during which individuals can enroll in or change plans due to a qualifying life event.
Updated
A Special Enrollment Period (SEP) is a time outside the annual Open Enrollment Period during which an individual can enroll in or change health insurance coverage because of a qualifying life event, such as marriage, birth or adoption of a child, loss of other coverage, or a move to a new coverage area.
SEPs are generally time-limited after the qualifying event, and the individual must provide documentation of eligibility.
In practice
When a patient reports a recent qualifying life event, eligibility staff confirm SEP eligibility and the new coverage effective date before billing services rendered after that date.
Commonly confused with
- Open Enrollment Period: OEP is the annual scheduled enrollment window; a SEP is event-triggered and available only to those with a qualifying life event.