Special Enrollment Period
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Special Enrollment Periods (SEP)
Special Enrollment Periods (SEP) allow for health insurance coverage enrollment any time during the year. Did you miss the opportunity to enroll in a Qualified Health Plan through Nevada Health Link? Although the deadline to enroll in coverage ended on Jan. 15th, you or a loved one may be eligible to enroll now if you report a life or income change.
When Your Life Changes, Your Health Coverage Could Too
Once you sign up for coverage through Nevada Health Link, you must report any life and income changes. This will ensure you continue to receive the correct coverage and savings for you and your family.
- If your income goes up or you lose a member of your household, you may qualify for less savings than you’re getting now. If you don’t report these changes, you could wind up having to pay back the difference when you file your federal tax return for the coverage year.
- If you were enrolled in health insurance coverage outside of Nevada Health Link (“off Exchange”) and your income has decreased making you newly eligible for advanced premium tax credits. You may qualify for a special enrollment period (SEP) to enroll in lower cost health insurance through Nevada Health Link.
- If your income goes down or you gain a household member, you could qualify for more savings than you’re getting now. This could reduce the amount you pay in monthly premiums. You could also qualify for Medicaid or Nevada Check-Up/CHIP coverage.
Qualifying Life Events:
Note for ALL QUALIFYING LIFE EVENTS: Special Enrollment Period do NOT include loss of coverage because you didn’t pay your premiums or if your coverage was taken away because of fraud or intentional misrepresentation. You may report a loss of qualifying health coverage up to 60 days before the loss of coverage.
If you’re enrolling in Marketplace coverage for the first time, you may need to submit documents to confirm that you qualify for a Special Enrollment Period.
See FAQ on how to submit documents for SEP
Read FAQ if you were denied Medicaid or NV Check Up outside of OEP or after you applied during OEP.
Loss of Health Coverage
Through a Job
Coverage through a job, or through another’s person’s job. This also applies if you’re now eligible for help paying for Nevada Health Link coverage because your employer stops offering coverage or the coverage is no longer considered qualifying coverage.
Loss of Medicaid or NV Check UP
Losing eligibility for Medicaid or NV Check Up (child ages off of Children’s Health Insurance Program CHIP).
Medicare
Losing eligibility for Medicare.
Expiration of Off-Marketplace Plan
If you lose coverage in any non-calendar year group health plan or individual health insurance coverage due to off-Marketplace plan or coverage expiring.
You may be eligible even if you have the option to renew your previous policy, including those enrolled on COBRA plans during group plan renewal time.
Turning 26
Your coverage through our parents usually ends the month you turn 26. Even if it’s outside Open Enrollment, you’ll be able to get a Marketplace plan because losing other coverage qualifies you for a Special Enrollment Period. You’ll have 60 days before you lose coverage and 60 days after that to enroll.
Change in Household Size
Marriage
At least one partner in a marriage related qualifying life event must demonstrate at least one day of coverage in 60 days prior to marriage, unless moving from
out of country.
The Marketplace recognizes any marriage legally enacted in a jurisdiction outside of Nevada and applies the federal definition of marriage, which includes same-sex couples.
Note: If you gained or became a dependent due to marriage, one spouse must have also had qualifying health coverage for one or more days in the 60 days prior to the marriage. This does not apply if the spouse:
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- Was living in a foreign country or a U.S. territory for one or more days in the 60 days prior to the marriage.
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- Is a member of a federally recognized tribe or a shareholder in an Alaska Native Corporation.
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- Lived for one or more days during the 60 days before their move or during their most recent enrollment period in a service area where they couldn’t get qualifying health coverage through the Marketplace.
Divorced or Legally Separated
Got divorced or legally separated and lost health insurance.
Please note: Divorce or legal separation without losing coverage doesn’t qualify you for a Special Enrollment Period.
Birth, Adoption, Foster Care
A child is born, adopted or received into foster care. The entire family can use the special-enrollment period to enroll in coverage.
For the birth or adoption of a child, or acceptance of a child into foster care, you can choose to have coverage start on:
- The first day of the month following the birth, adoption, or placement in your foster care of a child.
- On the date of the birth, adoption or placement in foster care.
- On the first day of the month following plan selection.
Change in Residency
Moving to New Service Area
Only if qualified individual or consumer and dependents become eligible for different QHPs as a result of the move between zip codes and change service areas OR the move is from outside the state.
Please note: Must demonstrate at least one day of coverage in 60 days prior to move, unless moving from out of country.
Moving to U.S.
Moving to Nevada from a foreign country or U.S. territory.
Moving to or from School
Moving to or from the place you attend school.
Please note: Must demonstrate at least one day of coverage in 60 days prior to move, unless moving from out of country.
Moving to or from Seasonal Employment
Moving to or from the place of your seasonal employment.
Please note: Must demonstrate at least one day of coverage in 60 days prior to move, unless moving from out of country.
Moving to or from a Shelter
Moving to or from a shelter or other transitional housing.
Please note: Must demonstrate at least one day of coverage in 60 days prior to move, unless moving from out of country.
Moving only for medical treatment or staying somewhere for vacation does not qualify you for a SEP. You qualify for SEP only if you had qualifying health coverage for one or more days in the 60 days prior to your move. This does not apply if:
- You were living in a foreign country or a U.S. territory for one or more days in the 60 days prior to the move.
- You are a member of a federally recognized tribe or a shareholder in an Alaska Native Corporation.
- You lived for one or more days during the 60 days before your move or during your most recent enrollment period in a service area where you couldn’t get qualifying coverage through Nevada Health Link.
Important: You must confirm you had qualifying health coverage for one or more days during the 60 days before your move by possibly having to submit documentation.
Other Qualifying Life Events, and other changes to report:
Domestic Abuse or Spousal Abandonment
You’re a survivor of domestic abuse/violence or spousal abandonment and want to enroll in your own health plan separate from your abuser or abandoner. Your dependents may be eligible too.
If you’re married to your abuser/abandoner, you can answer on your Marketplace application that you’re unmarried. You may be eligible for a premium tax credit and other savings on a Marketplace plan, if you qualify based on your income.
For People who Currently have Insurance through Nevada Health Link:
To remove a partner or dependent from an existing case, or to establish separate insurance, please contact our service center for assistance at (800) 547-2927.
Gaining U.S. Legal Status
You gained newly eligible immigration status. Get details on Marketplace eligibility for DACA recipients and certain other immigration statuses.
American Indian/Alaska Native
If you are American Indian or Alaska Native, you have access to a “special enrollment period” which allows you to enroll in health insurance any time throughout the year, essentially giving you a monthly open enrollment period, as opposed to being limited to the standard annual open enrollment window. Learn more about special provisions for American Indians and Alaska Natives.
Change in Financial Eligibility
A “Change in Financial Eligibility” special enrollment period allows you to change your health insurance plan outside of the regular open enrollment period if your income significantly changes, making you eligible for different coverage levels or subsidies on the marketplace due to this shift in financial status.
Release from incarceration (prison or jail)
After you’re released, you have a 60-day Special Enrollment Period to sign up for private health coverage.
Correction to name, date of birth, or social security number
An update to your information may potentially allow you to enroll in a new plan if necessary due to the correction.
Important: When you apply, you must attest that the information you provide on the application is true, including the facts that qualify you for a Special Enrollment Period.
For more information visit the FAQs on Special Enrollment Periods.
Prevailing on an Appeal
You believe you received an incorrect eligibility determination or an incorrect coverage effective date and file an appeal with the Exchange. If the ruling goes in your favor, you’ll be given the option to enroll in or change plans either retroactively or prospectively.
When to Report Changes:
You should report these changes as soon after the change occurs as possible.
If these changes qualify you for a Special Enrollment Period to change plans, in most cases you may have up to 60 days from the life event to enroll in new coverage. If the changes qualify you for more or less savings, it’s important to make adjustments as soon as possible.
How to Report Changes
- See if you qualify for a Special Enrollment Period due to a life event like the life changes listed above and contact Nevada Health Link as soon as possible.
- Contact Nevada Health Link by calling: 1-800-547-2927; email us at: CustomerServiceNVHL@exchange.nv.gov
- Important: Do not report these changes by mail.
- If you become eligible for a plan change mid-year due to a life event change be sure to consider the impact that variations in the new plan will have.
- Learn more about changing plans and how to report life changes for SEP by visiting our FAQ page
Steps to report changes in your Nevada Health Link account online:
- Log into your Nevada Health Link account and click “Edit Application.”
- The life change must be within 60 days of the current date to gain coverage during a Special Enrollment Period.
- Follow instructions on the screen to complete the application process. At the end of the application, you will click “Confirm Event and Finalize Plans.”Some qualifying life events will require you to submit documentation. If this is the case, you’ll receive a notification in your secure inbox.
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