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Learn about health insurance Special Enrollment Periods (SEPs)

Sometimes, you can still get health coverage after the Open Enrollment period ends each year on January 31.

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Important Information

BlueCross will no longer offer individual medical plans On or Off the Marketplace in three of the eight service areas of Tennessee in 2017. Individual medical plans won’t be available On or Off the Marketplace in the Memphis, Nashville or Knoxville regions beginning January 1.

We’re also simplifying our health plan options. In 2017, we’ll have four plans available – one bronze, two silver and one gold plan – all featuring Network SSM, our most popular provider network.

We know these changes will be difficult for some of our members, but by focusing on areas that would otherwise have no individual On/Off Marketplace coverage at all, we’ve made sure that all Tennesseans will have individual medical plans available to them. If you have questions, please call Member Service at 1-800-565-9140. We’re here to help. For more information and to see if plans will be available where you live, click here.

What's a Special Enrollment Period (SEP)?

SEPs are times when you can sign up for a new health insurance plan outside of Open Enrollment because you’ve experienced certain changes in your life, including:

Event

Enrollment Window

Coverage Takes Effect

Having a baby, adopting a child or placing a child in foster care

Up to 60 days after the event

The day of the event or the first day of the following month after you enroll. If you enroll in an individual Off-Marketplace plan on the first through the 15th of the month, your coverage will begin the first day of the next month. If you enroll on the 16th through the end of the month, your effective date will be the first day of the second following month.

Gaining a dependent through court order, including child support

Up to 60 days after the event

The day of the court order. You have options for your effective date when you enroll Off-Marketplace. If you enroll Off-Marketplace on the first through the 15th of the month, your coverage will begin the first day of the next month. If you enroll on the 16th through the end of the month, your coverage will begin the first day of the second following month.

Getting married

Up to 60 days after your marriage (you can’t enroll until after the marriage)

The first day of the month after you enroll.

Losing other health coverage

From 60 days before to 60 days after losing your other coverage

The first day of the month after you enroll and after the loss of coverage. If you enroll in an individual Off-Marketplace plan on the first through the 15th of the month, your coverage will begin the first day of the next month. If you enroll on the 16th through the end of the month, your coverage will begin the first day of the second following month.

Moving outside your insurance plan’s service area

Up to 60 days after the event

If you enroll on the first through the 15th of the month, your coverage will begin the first day of the next month. If you enroll on the 16th through the end of the month, your coverage will begin the first day of the second following month. If you enroll in an individual Off-Marketplace plan, you can also apply 60 days in advance of your move with coverage beginning the first day of the following month.

Becoming a U.S. citizen

Up to 60 days after the event (On-Marketplace only)

If you enroll on the first through the 15th of the month, your coverage will begin the first day of the following month. If you enroll the 16th through the end of the month, your coverage will begin the first day of the second following month.

Having a change in income or household status that qualifies you for financial assistance

Up to 60 days after the event (On-Marketplace only)

If you enroll on the first through the 15th of the month, your coverage will begin the first day of the next month. If you enroll the 16th through the end of the month, your coverage will begin the first day of the second following month.

If you’re signing up for any of the following reasons, you’ll need to send us documentation to show that the event took place:

  • Losing Minimum Essential Coverage (MEC)
  • Moving
  • Having a baby
  • Getting married
  • Gaining a dependent through adoption, placement for adoption, placement in foster care, or child support or other court order

Please be sure to include acceptable verification documents with your application. In case you forget, we’ll send you a SEP verification request letter. You’ll have 15 days from the date of the letter to send in your verification documents before your application is closed.

These are some of the acceptable forms of proof for each of these life changes:

Qualifying Event

Acceptable Verification Documentation

Birth / adoption / foster Care

  • Certified copy of birth certificate
  • Court order signed by judge

Permanent move

  • State of Tennessee automobile registration
    - Dated within the previous 60 days
  • Utility bills
    - Listing current and prior residence address, dated within the previous 60 days
  • Mortgage statement or lease agreement
    - Displaying address and dated within 60 days of the date of verification letter
  • Offer of employment at a Tennessee employer
    - Dated within the previous 60 days
  • Pay stub showing physical address

Non-calendar year policy expiration

  • Termination of coverage letter from prior health insurance carrier

Marriage

  • Marriage certificate

Loss of dependent

  • Certified copy of divorce decree
  • Death certificate or dated obituary
  • Court order

Loss of MEC

  • HIPAA certificate or termination of coverage letter from prior health insurance carrier
  • COBRA notice and election form from prior health insurance carrier or employer
  • COBRA notice of exhaustion of benefits
  • Letter from employer on company letterhead
    - Stating the reason for loss of coverage and date of termination
  • Discontinuance letter from department of health and welfare identifying loss of Medicaid coverage
    - Denial of coverage letter will not be accepted
  • A letter from the university informing the student of the loss of coverage, certificate of credible coverage and the previous year’s school transcripts
  • Death certificate or dated obituary
  • Court order
  • Dated copy of military discharge papers

Gain dependent

  • Court order

Visit our FAQ page if you're not sure if you signed up for your plan On- or Off-Marketplace. If you enrolled On-Marketplace, you may call the Centers for Medicare & Medicaid Services at 1-800-318-2596 to find out if you need to send in any verification documents.

Visit HealthCare.gov to find a full list of qualifying life events and learn more about SEPs.

There are a few other “complicated” situations that could qualify you for an SEP. Call us or your broker to find out more.