Special Enrollment Periods for Complex Cases in the Health Insurance Marketplace
Open enrollment for 2014 Marketplace coverage ends on March 31, 2014. A Special Enrollment Period (SEP) may allow you to enroll in health coverage outside of the Open Enrollment Period. For example, if you have a qualifying life event like having a baby or getting married, you can enroll in or change coverage outside of the Open Enrollment Period. Visit http://www.healthcare.gov/how-can-i-get-coverage-outside-of-open-enrollment to learn more about these qualifying life events.
If you believe you qualify for a Special Enrollment Period, call the Marketplace Call Center at 1-800-318-2596 and ask the representative. TTY users should call 1-855-889-4325. The representative will get information from you to determine if your circumstances qualify for a Special Enrollment Period. If so, the representative will help you apply and enroll in coverage.
If you’re enrolling through your state’s Marketplace and want to request a Special Enrollment Period, contact your state. Visit http://www.HealthCare.gov/marketplace/ to find the Marketplace that serves you.
If you’re already enrolled in a plan and you get a Special Enrollment Period, you can stay in your current plan in most cases, or you can switch plans. In some limited cases, you may qualify for an earlier effective date of coverage. Remember, you must make the first premium payment before your coverage becomes effective.
Filing an appeal
If your request for a Special Enrollment Period is denied, you have the right to file an appeal. If you appeal the Special Enrollment Period denial and the denial is found to have been incorrect, you can get coverage back to the date your Special Enrollment Period was denied.
You can file an appeal these ways:
• Visit http://HealthCare.gov/can-i-appeal-a-marketplace-decision/ to find and complete the appeal request form for the consumer’s state.
• Mail appeal documents to:
Health Insurance Marketplace
465 Industrial Blvd.
London, KY 40750-0061
When possible, please include a copy of any eligibility determination notice or other official notice you received. This is not required, but will help in the processing of your appeal. When mailing the appeal request to the Health Insurance Marketplace, include the last four digits of the London, KY address (40750-0061) so that your appeal is received and answered in a timely manner