What documents do I need to submit for an SEP?
Typically, you can enroll in health insurance once a year, during the annual Open Enrollment Period. However, if you have a Qualifying Life Event (QLE), such as having a baby or moving to a new state, you’ll also be able to enroll during a Special Enrollment Period (SEP). As part of this process, you may need to verify your eligibility and submit certain documents. Below are the main types of QLEs and examples of documents the government will accept to confirm your eligibility. Use this guide to make sure you have the documents needed when you apply for health insurance. We also created this FREE quick guide for you to refer back to when enrolling.
What are the main types of Qualifying Life Events?
Qualifying Life Events fall under the following main categories, with the first three being the most common:
- Loss of qualifying health coverage
- Change in primary residence
- Change in household size
- Change in eligibility for Marketplace coverage or for help paying for coverage
- Enrollment or plan error
There are also some exceptional circumstances that can count as QLEs. You can see that full list here.
If you’re not sure if you’ve experienced a QLE, use this simple tool to see if you’re eligible for an SEP.
What types of documents are accepted to confirm my loss of coverage?
The exact type of document to confirm your loss of qualifying health coverage will depend on how you lost coverage. All documents must show that you either lost qualifying health coverage in the past 60 days or will be losing that coverage in the next 60 days. Your name and the date of coverage lost must be stated in the document.
Here are some of the acceptable documents:
- A letter from your insurance company showing the termination of your health coverage.
- A loss of health insurance coverage letter from an employer. A letter stating that health insurance benefits have changed and your coverage will no longer count as a qualifying health plan under the Affordable Care Act will also work.
- A notification of being denied for Medicaid or CHIP, or a letter stating that your Medicaid or CHIP coverage ended or will end.
See the full list here.
What types of documents are accepted to confirm my change in primary residence?
To qualify for this QLE, you have to have moved in the past 60 days and have had qualifying health insurance for at least one day in the 60 days before your move, unless you were moving from another country or a United States territory.
This means you need to submit two sets of documents: one to prove your move and one to prove you had health coverage before the move. For the former, you can submit documents such as rental leases, mortgage papers, utility bills, or official mail from the government. Your new address and the date of your move must be in the documents. For the latter, you can submit documents such as a letter from an insurance company or an employer that confirms you had qualifying health coverage for at least 1 day in the 60 days before your move.
If you moved to the U.S. from another country or a U.S. territory, you won’t have to submit the health insurance coverage confirmation, but you will have to submit documents confirming your international move. Those from U.S. territories can submit a form of official identification showing their previous residence in a U.S. territory. While those from other countries can submit a copy of their passport with their U.S. admission stamp and date of entry.
To find more nuanced information about what’s acceptable in different situations, go here.
What types of documents are accepted to confirm my change in household size?
This category covers life events such as getting married, adding a child to the family, getting divorced, and having a death in the family. Legal or government-issued documents tied to these events are typically requested. For example, if you adopt a child, you must submit a letter or record of the adoption, signed by a court or government official. If you got married, you must prove it via a marriage certificate, license, affidavit, or other public or religious record of your marriage.
How do I submit the requested documents?
You will be notified of what documents are requested in your Eligibility Results Notice, which you should receive after you enroll. You have 30 days to submit these documents, either by mail or by uploading them.
If you enrolled via HealthCare.gov, the federally-run Marketplace, you can follow these instructions for uploading documents. Or you can mail them here:
Health Insurance Marketplace
Attn: Supporting Documentation
465 Industrial Blvd.
London, KY 40750-0001
You can also follow these steps if you enrolled via a privately-run Marketplace such as HealthSherpa. If you enrolled via a state-run Marketplace, please follow the instructions provided by your state exchange.
When does coverage start for Special Enrollment Period enrollees?
Typically, coverage for those enrolling during a Special Enrollment Period will start the first day of the month after you pick your plan or the first day of the second month after you pick your plan. The specifics depend on the type of qualifying life event you have as well as when you pick your new health insurance plan. If you have or adopt a child, however, coverage is retroactive to the date of the birth or adoption, as long as you pick a plan within 60 days and pay your premium.
Your Special Enrollment Period verification should be completed before your first day of coverage. In the case that confirmation is taking longer than usual, your coverage will be retroactive once you are confirmed and have paid the premium.
Still have questions? Call the HealthSherpa Consumer Advocate team at (855) 772-2663 and they can help you with your questions and enroll you in the right plan for you.