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.
Highmark Blue Cross Blue Shield serves the 29 counties of western Pennsylvania and 13 counties of northeastern Pennsylvania. Highmark Blue Shield serves the 21 counties of central Pennsylvania and also provides services in conjunction with a separate health plan in southeastern Pennsylvania. Highmark Blue Cross Blue Shield West Virginia serves the state of West Virginia plus Washington County. Highmark Blue Cross Blue Shield Delaware serves the state of Delaware. Highmark Western and Northeastern New York Inc., serves eight counties in Western New York under the trade name Highmark Blue Cross Blue Shield of Western New York and serves 13 counties in Northeastern New York under the trade name Highmark Blue Shield of Northeastern New York. Each of these companies is an independent licensee of the Blue Cross Blue Shield Association. Blue Cross, Blue Shield and the Blue Cross and Blue Shield symbols are registered marks of the Blue Cross Blue Shield Association, an association of independent Blue Cross and Blue Shield companies. 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.
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