HHS is taking new steps to strengthen the integrity of special enrollment periods (SEPs)
The Health and Human Services (HHS) is taking new steps to strengthen the integrity of special enrollment periods (SEPs) and to simplify rules for the Consumer Operated and Oriented Plan (CO-OP) program to allow them to more easily raise capital. These changes were initiated in order to improve stability in the Health Insurance marketplace and help consumers? access to quality, affordable coverage.
Special Enrollment Periods (SEPs)
It?s equally important to avoid SEPs being misused or abused, while special enrollment periods (SEPs) provide a critical pathway to coverage for qualified individuals who experience qualifying events and need to enroll in or change qualified health plans (QHPs) outside of the annual open enrollment period. The Health and Human Services (HHS) is tightening the rules for certain special enrollment periods and making clear that SEPs are only available in six defined and limited types of circumstances. New rules limit the circumstances in which someone may qualify for the permanent move special enrollment periods (SEPs) to ensure consistency with the original purpose of that SEP.
The Health and Human Services (HHS) is also making conforming changes to ensure that individuals who were incarcerated, or were previously in the coverage gap in a non-Medicaid expansion state and have moved and become newly eligible for advance payments of the premium tax credit may continue to qualify for a special enrollment period. Because these individuals were previously unable to have minimum essential coverage or exempt from having minimum essential coverage prior to the qualifying event that qualifies them for this special enrollment periods (SEPs), it is not required that they had prior minimum essential coverage to qualify for an special enrollment periods (SEPs).
Finally, clarified in separate guidance that SEPs are only available in six defined and limited types of circumstances:
- Losing other qualifying coverage,
- Changes in household size like marriage or birth,
- Changes in residence, with significant limitations,
- Changes in eligibility for financial help, with significant limitations,
- Defined types of errors made by Marketplaces or plans, and
- Other specific cases like cycling between Medicaid and the Marketplace or leaving Americorps coverage.