How to help consumers apply for a special enrollment period (SEP). Use the following links to skip to a topic on this page.
Tips to Avoid Delays
Have complete information before you call: Only call the ARC or Broker Service Line about a consumer's qualifying life event when you are ready to report it. If you have questions about what kinds of events qualify for a SEP, see Qualifying Life Events. For MNsure to determine whether a consumer’s situation qualifies for a SEP, we must complete a full SEP application, which requires complete information.
Manage your calls to the ARC / Broker Service Line. Reminder that assisters are limited to six case status requests over the phone per day (three per call) if the consumer is not present. After this, they will be directed to the Case Status Request (CSR) form.
Remind Consumers to Report ALL Changes: Consumers should report application changes even if they are not applying for a SEP. Changes could change their eligibility.
Length of SEP
As a general rule, a consumer’s special enrollment period is 60 calendar days following their qualifying life event (QLE). After that time period the consumer cannot enroll in or change plans until the next open enrollment period or they qualify for another SEP.
For certain qualifying events, a consumer may access their special enrollment period up to 60 calendar days prior to the date of their QLE to enroll.
For example, if a consumer will be losing their existing coverage on 3/31, they could select their plan and request a SEP up to 60 days prior to 3/31. If the SEP is approved, coverage could not start until after the loss of coverage. If they do not choose to enroll prior to 3/31, they will still have 60 days after that date to enroll.
Early access to a SEP is available for the following qualifying events:
- Loss of minimum essential coverage
- Newly eligible for advanced premium tax credit (APTC) or cost-sharing reductions (CSR) due to a change in employer-sponsored insurance (ESI)
For all other SEPs, the consumer has to experience the event before being eligible to enroll.
SEP Coverage Start Dates
Below is general information about regular and optional coverage start dates. See Qualifying Life Events for more details about when coverage can start.
Regular coverage effective dates normally apply based on regular effective date rule, also called the “15/16 rule.” This means:
- For a plan selected on the first through the 15th of the month, coverage is effective the first of the following month.
- For a plan selected on the 16th through the last day of the month, coverage is effective the first day of the second following month.
- For example, if a plan is selected on August 12, the coverage is effective September 1. If a plan is selected on August 30, the coverage is effective October 1.
Reminder: For coverage to start, the consumer must have submitted an application, selected a plan AND called MNsure prior to the end of the SEP.
Special Effective Dates
Some qualifying life events have special effective dates available. For the loss of minimum essential coverage (MEC), including MA or MinnesotaCare coverage, the coverage effective date is the first day of the month following the date of plan selection, but not before the loss of other coverage. For example, if an individual will lose MA coverage August 31 and selects a QHP on August 18, coverage would be effective September 1.
Some qualifying life events provide options for the effective dates, such as:
- Gain of dependent due to birth, adoption, foster care or child support order
- Loss of dependent due to death or divorce
- Enrollment due to MNsure error
Example: A family that wants to add a newborn to their coverage may choose one of these effective dates:
- Retroactive to the newborn’s date of birth, or
- the first day of the month following the birth, or
- according to regular effective date rules.
Basic SEP Process
- The consumer experiences a qualifying life event.
- The consumer applies/enrolls on MNsure.org
- The consumer MUST call the Contact Center to confirm their eligibility for a SEP.
- In general, the Contact Center takes the following steps:
- Confirm that the consumer selected a plan.
- Verify the consumer’s identity, read the Tennessen Warning, and verify attestation of the qualifying life event.
- Gather information from the consumer and determine if the consumer is eligible for a SEP. (If the consumer is not eligible the Contact Center will notify the consumer.)
- Inform the consumer about effective dates and whether verification documentation is needed (if the consumer is eligible)
- Create a request for verification notice, if appropriate.
- If no pre-enrollment verification is needed, verify that an enrollment record is created, or if needed, will create a manual enrollment.
- If pre-enrollment verification is needed, notify the consumer they will have 30 days from the date of the notice to provide the verification documentation, and that verification must be provided or the enrollment/enrollment changes will not take place. Instructions regarding how to provide the verification will be on the request notice.
Note for assisters:
- Brokers can call the Broker Service Line to confirm the consumer’s eligibility for a SEP.
- Navigators and CACs can call the ARC to confirm the consumer’s eligibility for a SEP. The consumer must be physically present, or on the call at the time the call is initiated. ARC staff must speak with the consumer to verify three pieces of personally identifiable information and give data privacy and security attestation warnings. The consumer may then authorize the navigator or CAC to complete the SEP with the ARC.
All SEPs require some kind of proof (verification). Some SEPs allow verifications to be submitted after SEP eligibility has been determined. Other SEPs need “pre-verification.”
Pre-enrollment verification requires MNsure to hold certain SEP enrollments until the applicant/enrollee provides documentation proving their qualifying life event. MNsure will wait to send the enrollment to the health insurance company until after the consumer has submitted the verifications, and MNsure has verified that the documents meet the requirements for the SEP.
Basic Pre-Verification Process
- Consumer calls the Contact Center to determine eligibility for the SEP, at which time the Contact Center will inform the consumer whether or not verifications are required.
- If required, a SEP verification request notice is triggered. Note: SEP notices will not appear in the notifications area of the consumer’s account.
- Enrollees will have 30 days from date the verification request is sent to fulfill the verification request.
- The enrollment will be processed and sent to health insurance company upon receipt of acceptable verification documents.
- When an enrollee is required to pay two or more months of retroactive premiums in order to effectuate coverage, the enrollee must be given the option to start coverage based on the original effective date or move the start ahead no more than one month. If the consumer is eligible for this option, they have 14 days to call MNsure to change their plan’s effective date.
For more information and guidance, see the resource links on this page.
Submitting Pre-Verification Documents
Consumers must submit a copy of at least one of the documents listed on the notice.
The first and last name and case number (from the notice) should be written on all documents submitted.
Documents can be submitted to MNsure in the following ways:
- Fax documentation (along with the first page of the notice) to 651-431-7770.
- Mail documentation (along with the first page of the notice) using the enclosed return envelope.
- Upload documentation at https://www.mnsure.org/verify-qhp.jsp.
Tips for Uploading Supporting Documentation
- The Documentation Upload site cannot be used for cases that are public program only.
- The upload site can only be used for QHP and mixed-eligibility household cases.
- The upload site cannot be used the same day a SEP is requested.
- Consumers should be able to upload their documents the day after requesting a SEP.
- Make sure the consumer’s name, date of birth, and case number is on each page of the uploaded document.
- The preferred way to use the upload site is to wait for the consumer to receive their SEP notice from MNsure and use the information on that notice to enter the required information.
- If you are using the upload site without a notice, skip the section asking to upload the first page of the verification notice.
- ARC and Broker Service Line staff are unable to provide information on whether a verification has been received in real time. Please wait a few days and use the Case Status Request form for this information.
- Sample notices for the SEP verification process are in the 2019 SEP Guide for Assisters (PDF)
- A detailed guide with screenshots on how to use the document upload site (PDF)