Assister resources to help consumers apply for SEP.
NEW- SEP for Decrease in Household Income
Consumers looking to enroll utilizing the SEP for decrease in household income will need to follow these steps:
If the consumer already has an application through MNsure, they can follow the SEP Process for Current Consumer section below.
If the consumer is new to MNsure, they will first need to create an account and complete an application to determine if they are eligible for a qualified health plan (QHP).
- If the consumer receives eligibility for a QHP, navigate to mnsure.org and enter the phrase "enrollment upload" into the search bar.
- Select the link to "send documents to verify your life event."
- Upload the following:
- Documents that support a decrease in household income.
- Document that proves the household had minimum essential coverage (MEC) at least 1 day in the past 60 days.
- Wait at least 10 minutes after uploading documents.
- Contact the ARC or Broker Service Line (BSL) to complete the remainder of the SEP reporting process.
- Tell the ARC/BSL agent that the call is to confirm the consumer’s eligibility for the SEP for decrease in household income.
- The ARC/BSL agent will ask questions necessary to complete the SEP questionnaire in the shopping and enrollment platform.
- The ARC/BSL agent will then review the uploaded documents to confirm that they support the eligibility criteria for this SEP.
- If approved, while on the call, the ARC/BSL agent will open shopping to allow the consumer to enroll.
- If not approved, the ARC/BSL agent will provide guidance on what is needed to confirm eligibility for the SEP.
More information on this qualifying life event (QLE) can be found on MNsure.org.
If the consumer already has an application through MNsure, they should follow the SEP Process for Current Consumer section below.
SEP Process for New Consumers
MNsure.org has examples of qualifying life events that allow new consumers to enroll outside of open enrollment and instructions for consumers on how to apply for a special enrollment period.
- A new consumer will need to create an account/complete an application to determine if they qualify for a qualified health plan (QHP) with or without financial assistance AND if they qualify to shop and enrollment in health care plans through MNsure outside of the open enrollment period.
- If a consumer receives eligibility for a QHP, select the Enroll in Plans button from the eligibility results screen to launch the shopping and enrollment platform.
- Select the Confirm Event button on the consumer’s dashboard in the shopping and enrollment platform.
- Select the qualifying life event and enter the date the qualifying life event occurred.
- If the event can be confirmed, instructions will be provided from the shopping and enrollment platform to submit SEP verification documentation either by mail or the upload tool. Additional information about verifications.
SEP Process for Current Consumers
MNsure.org has examples of qualifying life events that allow consumers with an existing application to change plans or enroll in new plans outside of open enrollment. There are also instructions for consumers on how to apply for a special enrollment period.
- Assisters will need to notify MNsure if a consumer has experienced a qualifying life event using the Report a Change process.
- After reporting a change, if the consumer is eligible to enroll in a QHP during a special enrollment period:
- The consumer will be contacted and assisters will receive a secure email confirming next steps.
- The assister may need to log in to the shopping and enrollment platform and select the Confirm Event button on the consumer’s dashboard in the shopping and enrollment platform.
- Select the qualifying life event and enter the date the event occurred.
- Once the event is confirmed plan shopping and enrollment will be available to the consumer.
Any notices sent to consumers that were not manually created by MNsure can be viewed in the consumer’s inbox in the shopping and enrollment platform.
Most SEPs require some kind of proof (verification). See Verifications for more information.
SEP eligibility: See Qualifying Life Events for questions about what kinds of life events may provide eligibility for a SEP. 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. Remember to use the Case Status Request (CSR) form whenever possible.
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.