Outside of the annual Open Enrollment Period that starts November 1, an SEP is your only other opportunity to enroll in a new individual or family plan in any given year.
What qualifies for SEP?
Under Affordable Care Act (ACA) guidelines, experiencing a major life event — like an addition to your family, a move to a new ZIP code, or job loss — could qualify you for a Special Enrollment Period (SEP).
All ACA plans cover preexisting conditions, plus the 10 Essential Health Benefits:
Hospitalization (like surgery and overnight stays)
Pregnancy, maternity, and newborn care
Mental health and substance use disorder services
Rehabilitative and habilitative services and devices
Preventive and wellness services and chronic disease management
Pediatric services, including dental and vision care
You'll need documentation of your qualifying life event. It will differ depending on what life event you’re facing, but might include:
A letter from your employer
A birth certificate
A marriage certificate
The Affordable Care Act
The Affordable Care Act (ACA) — sometimes called Obamacare — is the health care reform law that makes health plans available to you when you're not covered by your employer or by federal programs such as Medicaid.
There are two ways to buy Affordable Care Act (ACA) plans, also known as Obamacare.
Highmark marketplace plans
You can buy Highmark plans through an online marketplace, also known as the federal or state Exchange. If you're eligible for financial help, these plans can lower your monthly and out-of-pocket costs.
All references to “Highmark” in this document are references to the Highmark company that is providing the member’s health benefits or health benefit administration and/or to one or more of its affiliated Blue companies.
This website is operated by Highmark, Inc. and is not the Health Insurance Marketplace website. It also does not display all Qualified Health Plans available through the Health Insurance Marketplace website. To see all available Qualified Health Plan options, go to the Health Insurance Marketplace website at HealthCare.gov.
Highmark Blue Cross Blue Shield or Highmark Blue Shield are Medicare Advantage HMO, PPO, and/or Part D plans with a Medicare contract. Enrollment in these plans depends on contract renewal.
®Blue Cross, Blue Shield and the Cross and Shield symbols are registered service marks of the Blue Cross Blue Shield Association, an association of independent Blue Cross and Blue Shield plans. Benefits and/or benefit administration may be provided by or through the following entities, which are independent licensees of the Blue Cross Blue Shield Association: Western and Northeastern PA: Highmark Inc. d/b/a Highmark Blue Cross Blue Shield, Highmark Choice Company, Highmark Health Insurance Company, Highmark Coverage Advantage Inc., Highmark Benefits Group Inc., First Priority Health, First Priority Life or Highmark Senior Health Company. Central and Southeastern PA: Highmark Inc. d/b/a Highmark Blue Shield, Highmark Benefits Group Inc., Highmark Health Insurance Company, Highmark Choice Company or Highmark Senior Health Company.
PA: Your plan may not cover all your health care expenses. Read your plan materials carefully to determine which health care services are covered. For more information, call the number on the back of your member ID card or, if not a member, call 866-459-4418.
Delaware: Highmark BCBSD Inc. d/b/a Highmark Blue Cross Blue Shield.
West Virginia: Highmark West Virginia Inc. d/b/a Highmark Blue Cross Blue Shield, Highmark Health Insurance Company or Highmark Senior Solutions Company. Visit our website to view the Access Plan required by the Health Benefit Plan Network Access and Adequacy Act. You may also request a copy by contacting us at the number on the back of your ID card.
Western NY: Highmark Western and Northeastern New York Inc. d/b/a Highmark Blue Cross Blue Shield.
Northeastern NY: Highmark Western and Northeastern New York Inc. d/b/a Highmark Blue Shield.
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