Reference
ACA marketplace SEP qualifying events
28 entries.
Entries
28
Loss of job-based health coverage
Loss of job-based health coverage: Termination/layoff/reduction in hours below benefits threshold. 60-day SEP from coverage loss date.
Loss of individual coverage
Loss of individual coverage: Plan no longer available, coverage termination by issuer. 60-day SEP from loss.
Loss of Medicaid or CHIP eligibility
Loss of Medicaid or CHIP eligibility: Redetermination + over income or other. 60-day SEP from loss + 60-day before.
Marriage
Marriage: Married within past 60 days. 60-day SEP.
Divorce
Divorce: Divorce that ended coverage. 60-day SEP from loss of coverage.
Loss of coverage as a dependent
Loss of coverage as a dependent: Aging off parent's plan (age 26), divorce, death. 60-day SEP.
Birth, adoption, or placement for adoption
Birth, adoption, or placement for adoption: Adding new family member. 60-day SEP from event.
Permanent move (gaining new plan options)
Permanent move (gaining new plan options): Moving to area where different plans available. 60-day SEP after move.
Becoming a US citizen, national, or lawfully present
Becoming a US citizen, national, or lawfully present: Newly eligible. 60-day SEP from status.
Release from incarceration
Release from incarceration: Released from jail/prison. 60-day SEP from release.
AHP or SHOP enrollment changes
AHP or SHOP enrollment changes: Employer offers new plan or changes contributions. 60-day SEP.
Enrollment error or misconduct
Enrollment error or misconduct: Exchange/issuer error preventing enrollment. 60-day SEP after resolution.
Plan substantial violation of its terms
Plan substantial violation of its terms: Carrier substantial breach of contract. 60-day SEP.
Newly eligible/ineligible for APTC
Newly eligible/ineligible for APTC: Income or family changes affecting subsidy. 60-day SEP.
Newly eligible/ineligible for CSR
Newly eligible/ineligible for CSR: Plan-specific cost-sharing eligibility change. 60-day SEP.
Becoming Medicare eligible — losing other coverage
Becoming Medicare eligible — losing other coverage: 65 or disability Medicare onset. Medicare SEP typically.
American Indian / Alaska Native — monthly enrollment
American Indian / Alaska Native — monthly enrollment: Tribal members can enroll month-to-month. Open enrollment year-round.
Domestic violence survivor
Domestic violence survivor: Specific SEP for spouse separated from abuser. 60-day SEP.
Loss of pregnancy-related Medicaid
Loss of pregnancy-related Medicaid: Post-partum Medicaid termination. 60-day SEP from loss.
Employer changes plan offerings affecting eligibility
Employer changes plan offerings affecting eligibility: Employer modifies benefits. 60-day SEP.
Hardship exemption qualifying event
Hardship exemption qualifying event: Specific hardship circumstances. 60-day SEP.
Aging out of foster care
Aging out of foster care: Specifically for former foster youth ≤26. Year-round enrollment for former foster youth ≤26.
Involuntary loss due to employer termination
Involuntary loss due to employer termination: Employer dissolution/bankruptcy. 60-day SEP.
Furlough resulting in coverage loss
Furlough resulting in coverage loss: Hours reduction below benefits threshold. 60-day SEP.
Medicaid termination for procedural reasons (e.g., paperwork)
Medicaid termination for procedural reasons (e.g., paperwork): Procedural termination, not income-based. 60-day SEP.
Expiration of COBRA coverage
Expiration of COBRA coverage: End of 18-36 month COBRA period. 60-day SEP from COBRA exhaustion.
Plan benefits substantial change mid-year
Plan benefits substantial change mid-year: Significant benefit reduction. 60-day SEP.
Other exceptional circumstances
Other exceptional circumstances: Case-by-case SEP per exchange. 60-day SEP from event.
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