Special Enrollment Period

Know the Difference between Open Enrollment and Special Enrollment Period

Open Enrollment Period

The Open Enrollment Period is the yearly timeframe when you can enroll in health insurance plans for family or individual needs, and typically runs from November 1 to January 15 of the following year. You do not need a qualifying life event to enroll in a health insurance plan during the Open Enrollment Period.

A Special Enrollment Period (SEP) is a time outside the Open Enrollment Period when an individual can enroll in an Individual & Family Health Plan.

In order to enroll for SEP, one must experience a qualifying life event and provide proof of eligibility. Enrollment is available through the Virginia's Insurance Marketplace or directly through our website.

Individuals and/or their dependents have 60 days to enroll for health coverage after experiencing a qualifying life event. Some examples of qualifying life events are getting married, having a baby, or gaining U.S. citizenship.

Virginians who lose their Medicaid coverage have 90 days to enroll in a qualified health insurance plan. You can apply and enroll in Medicaid or the Children's Health Insurance Program (CHIP) any time of year if you qualify.

For more information talk to a Sentara Personal Plan Advisor at 1-844-206-3208.

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Frequently Asked Questions

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How soon can coverage start during a special enrollment period?

All qualifying life events allow you to begin coverage on the first day of the next month.

For example, if you enroll between May 1^st and May 31^st, your coverage will begin June 1^st.

However, there are a few exceptions which allow same-day effective coverage to begin:

Birth of child
Adoption of child

What qualifying life events allow an individual to enroll in health insurance coverage using a Special Enrollment Period?

Qualifying life events are significant changes that enable an individual to enroll in personal health insurance coverage outside of the Open Enrollment Period. These qualifying life events may cause you to lose your health coverage or have a change in family status or residency. Examples include:

Losing Your Health Coverage

Losing coverage because your current health insurance carrier left the service area
Losing job-based coverage for any reason including resigning, getting laid off, or getting fired
Expiring COBRA coverage
Losing coverage under your parent's plan at age 26
Getting divorced or legally separated (resulting in loss of coverage)
Losing eligibility for Medicaid or the Children's Health Insurance Program (CHIP)

Note: Losing coverage that doesn't qualify as minimum essential coverage doesn't qualify you for a Special Enrollment Period. Learn more at Virginia's Insurance Marketplace.

Change in Your Household Size

Getting married
Having a baby
Adopting a child or placing a child for adoption or foster care
Death of family member (causing you to lose eligibility in your current plan)

Change in Circumstance

Permanently moving outside your plan’s coverage area
Gaining or losing income (affecting eligibility for premium tax credits or cost-sharing reductions)

Change in Status

Getting released from jail or prison
Gaining citizenship or lawful presence in the U.S.

For more information on required documentation, please visit Virginia's Insurance Marketplace.

Still not sure what to do? Talk to a Sentara Personal Plan Advisor now at 1-844-206-3208.

Don't have time to talk right now? Have one of our Plan Advisors reach you instead.

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How Long Does the Special Enrollment Period Last?

A Special Enrollment Period is triggered by a qualifying life event and typically lasts for 60 days. However, the Special Enrollment Period may vary based on the type of qualifying life event.

Qualifying Life Event	Special Enrollment Period (SEP)
Qualifying Life EventGetting Married	Special Enrollment Period (SEP)Up to 60 days after the event.
Qualifying Life EventHaving a baby, adopting or placing a child for adoption	Special Enrollment Period (SEP)Up to 60 days after the event.
Qualifying Life EventLosing your health coverage	Special Enrollment Period (SEP)Up to 60 days before and up to 60 days after the event.
Qualifying Life EventMoving outside your plan's coverage	Special Enrollment Period (SEP)Up to 60 days after the event. Note: Only triggers SEP if it's not during open enrollment.
Qualifying Life EventGaining U.S. citizenship	Special Enrollment Period (SEP)Up to 60 days after the event. Note: Only triggers SEP if it's not during open enrollment.
Qualifying Life EventChange in income or household status that affects eligibility for premium tax credits or cost-sharing reductions	Special Enrollment Period (SEP)Up to 60 days after the event. Note: Only triggers SEP if it's not during open enrollment.
Qualifying Life EventLosing Medicaid coverage	Special Enrollment Period (SEP)Up to 90 days after the event.
Qualifying Life EventRelease from prison or jail	Special Enrollment Period (SEP)Up to 60 days after the event. Note: Only triggers SEP if it's not during open enrollment.
Qualifying Life EventHardship Exemption*	Special Enrollment Period (SEP)Up to 60 days after the event.

¹A hardship exemption is an exceptional circumstance, and it triggers a 60-day Special Enrollment Period. Examples of exceptional circumstances are unexpected hospitalizations, natural disasters or temporary cognitive disability. Other hardships may include enrollment errors created by the Virginia's Insurance Marketplace, your broker or by your insurance carrier.