UHC Individual & Family Plans

Open Enrollment (OE) VS. Special Enrollment Period (SEP)

What is the difference between an OE and SEP for Individual & Family plans?

Open Enrollment (OE):

An Open Enrollment Period is a window of time that happens once a year (starts November 1st and ends January 15th) when someone can sign up for health insurance or adjust their current plan for the upcoming year without having a qualifying event.

Special Enrollment (SEP):

A Special Enrollment Period is a time outside of the yearly Open Enrollment Period during which an eligible person may enroll in a Qualified Health Plan or change from one plan to another because of a qualifying event such as:

• Involuntary loss of Minimum Essential Coverage (job loss, COBRA benefits ending, turning 26, etc.) (See link below)

• Becoming newly married or divorced

• Having a baby or adopting a child

• Death of the primary policyholder in the family

• Moving to a different zip code or county that changes your health plan area

• Losing eligibility for Medicare, Medicaid or CHIP

The following are NOT qualifying events:

  • Loss of coverage due to failure to pay full premium

  • Loss of short-term or temporary coverage or travel insurance

  • Voluntarily opting out of affordable employer-provided coverage

  • Voluntarily cancelling coverage before the policy renewal or end date

  • Voluntarily cancelling COBRA before it ends

  • Loss of state or federal benefits or assistance due to failure to provide necessary documents or verification

A person applying for coverage as a result of a qualifying event must provide valid supporting documents showing that a qualifying event occurred within 60 calendar days of the date the application was received. *Documentation will depend on the event and could include, but are not limited to the following:

  • Birth certificate, adoption record, legal guardianship document or court order

  • Marriage license and proof of prior qualifying health coverage with the last 60 days

  • Cobra documentation showing length of coverage with beginning and end dates

  • Letter from health insurance company showing coverage termination date (Certificate of Creditable Coverage)

  • Divorce papers including the ending of health care responsibility and proof of prior qualifying health coverage within the last 60 days

  • Death Certificate and proof of prior qualifying health coverage within the last 60 days

  • Notification of reaching maximum age or termination of coverage letter/email from insurer with last day of coverage

  • *BCBS of IL may require more than one type of document for some qualifying events