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Guide to Special Enrollment Period

The table below shows details about the life events that may qualify you for a special enrollment period. (Download the MNsure Special Enrollment Guide as a PDF.)

A special enrollment period (SEP) is a period of time when you may enroll in a private health plan or change enrollment to another private plan if you experience a qualifying life event. Generally, the special enrollment period begins on the date the qualifying life event takes place (regardless of when you report the life event) and ends 60 calendar days later. Any plan selections must be made before the end of the special enrollment period. You are responsible to pay the premium amount billed by the insurance company to ensure coverage. If you are already enrolled in coverage you purchased through MNsure and have experienced a qualifying life event, call the MNsure Contact Center at 1-855-366-7873.

You may need to provide additional documentation to verify that you qualify for enrollment. MNsure will contact you if additional documentation is required.

Life event type, when it starts, when to enroll and deadlines.
Qualifying life event When does my 60-day SEP begin? When do I enroll? When does my coverage start?

Loss of qualifying health care coverage

Includes loss of employer-sponsored coverage by you or your dependent (includes end of continuation coverage such as COBRA and retiree coverage)

Includes loss of coverage because an employer ends coverage

Includes loss of coverage because you or your spouse lose or leave a job

Includes end of your non-calendar year plan

Includes loss of Medical Assistance (MA) or MinnesotaCare

Includes loss of other government-sponsored coverage such as CHAMPUS or TRICARE

Note: Voluntary loss of coverage because premiums were not paid on time, including COBRA premiums, does not qualify for a SEP.

The last date you or your dependent is covered by (or eligible for) a qualifying health plan

Any time during your SEP

An individual or dependent can apply and pick a QHP during the 60 days prior to loss of coverage in order to avoid a gap in health care coverage

First day of the month following date of plan selection, but not before your other qualifying health coverage ends.

Change in household size – due to marriage

Date of marriage Any time during your SEP First day of the month following date of plan selection

Change in household size – due to birth, adoption, placement for adoption or foster care, or child support court order

Date of birth, adoption placement, or court order Any time during your SEP

Options:
1. Retroactive to date of birth, adoption, placement or court order, or
2. First day of the month following the date of birth, adoption or placement, or
3. Regular effective date based on plan selection received:

  • 1st - 15th of month, coverage begins the following month
  • 16th - end of month, coverage begins two months out

Enrollee who has a change in household size – due to loss of dependent(s) due to death or divorce

Date of death or date of divorce Any time during your SEP

Options:
1. First day of the month following date of plan selection; or
2. Regular effective date based on plan selection received:

  • 1st - 15th of month, coverage begins the following month
  • 16th - end of month, coverage begins two months out

Change in permanent residence

You gain access to new QHP options as the result of a permanent move; AND you had qualifying health coverage for at least one day in the 60 days before your move.

If you move to Minnesota from a foreign country or from a U.S. territory, then you can qualify without having had qualifying health coverage prior to the move.

Date of move

Any time during your SEP

 

Plan selection received:

  • 1st - 15th of month, coverage begins the following month
  • 16th - end of month, coverage begins two months out

For plans selected prior to the move, first day of the month following the date of your move.

Change in eligibility for coverage through MNsure – enrollee who is newly eligible or ineligible for APTC or CSR

Includes you or your dependent who is already enrolled in QHP through MNsure and is newly eligible for advanced premium tax credit (APTC) or cost-sharing reduction (CSR).

Note: changes in amount of existing APTC or CSR does not qualify for a SEP.

Date of eligibility determination notice Any time during your SEP

Plan selection received:

  • 1st - 15th of month, coverage begins the following month
  • 16th - end of month, coverage begins two months out

Change in eligibility for coverage through MNsure – change in employer-sponsored insurance causing new APTC or CSR eligibility

Includes you or your dependent who is enrolled in employer-sponsored health insurance and becomes newly eligible for APTC or CSR because of a change to employer-sponsored health insurance coverage

Change includes change to plan benefits causing them to become unaffordable or lose minimum value.

Date of change to plan benefits or cost

Any time during your SEP

You or your dependent can apply for a QHP during the 60 days prior to the change to employer-sponsored insurance plan benefits or cost to ensure no gap in health care coverage.

First day of the month following date of plan selection, but not before the change to employer-sponsored insurance plan benefits or cost.

American Indian or Alaska Native

A qualifying tribal member's dependents can enroll in or change plans with the qualifying individual if they are on the same application for coverage

SEP starts at the beginning of each month and ends on the final day of the month

Any time during your SEP

Plan selection received:

  • 1st - 15th of month, coverage begins the following month
  • 16th - end of month, coverage begins two months out

Change in eligibility for coverage through MNsure – due to gain of citizen, national, or lawfully present status or change in incarceration status

Date of status change Any time during your SEP

Plan selection received:

  • 1st - 15th of month, coverage begins the following month
  • 16th - end of month, coverage begins two months out

Enrollment error – due to agency error, mistake, misrepresentation or inaction

You think that you or your dependent's enrollment, disenrollment, or lack of enrollment in QHP was incorrect and due to MNsure error or inaction or misconduct on part of an enrollment assistance service

Date you report the error to MNsure, if timely Any time during your SEP

MNsure will correct or eliminate the effects of the error, inaction or misconduct, including coverage options:
1. Date coverage would have started without the error, inaction or misconduct; or
2. The first of the month following plan selection.

Enrollment error – due to violation in material provision of QHP contract

Date you report the violation to MNsure

Depends

MNsure will work with insurance company to correct or eliminate the effects of the violation

Other qualifying events - exceptional circumstances

You report to MNsure that you or your dependents are victims of domestic abuse or spousal abandonment

MNsure determines that failure to enroll during enrollment period is not within an individual's control or due to individual fault

AmeriCorps members starting or ending their service

Upon request for special enrollment period due to domestic abuse or spousal abandonment

Case by case (for circumstances out of individual's control)

Date of start or end of AmeriCorps service

Any time during your special enrollment period

Case by case

Plan selection received:

  • 1st - 15th of month, coverage begins the following month
  • 16th - end of month, coverage begins two months out

Case by case

*Employer-sponsored insurance meets the "minimum value standard" if the plan's share of the total allowed benefit costs covered by the plan is no less than 60 percent of such costs (26 CFR 1.36B-2(c)(3)(v)(C)(vi)). Employer-sponsored insurance is unaffordable if the portion of the annual premium the employee must pay for self-only coverage exceeds 9.5% of the employee's household annual income (26 CFR 1.36B-2(c)(3)(v)(A)).

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