Special Enrollment Periods

Lost your health insurance? Highmark can help.

Special Enrollment details

  • When is SEP?


    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).

The 10 essential health benefits

All ACA plans cover preexisting conditions, plus the 10 Essential Health Benefits:

  • Outpatient care
  • Emergency services
  • Hospitalization (like surgery and overnight stays)
  • Pregnancy, maternity, and newborn care
  • Mental health and substance use disorder services
  • Prescription drugs
  • Rehabilitative and habilitative services and devices
  • Laboratory services
  • Preventive and wellness services and chronic disease management
  • Pediatric services, including dental and vision care

Documentation

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.

What’s a qualifying life event?

Loss of health coverage
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  • Losing existing health coverage, including job-based, individual, and student plans
  • Losing eligibility for Medicare, Medicaid, or CHIP
  • Turning 26 and losing coverage through a parent's plan
  • If you know in advance that you’re losing your insurance coverage, you may apply up to 60 days prior to your end date.
  • You will need documentation, like a letter from your employer, that your coverage is ending. It will differ depending on what life event you are facing.
Changes in household
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  • Marriage or divorce
  • Birth or adoption of a child
  • Death in the family
Changes in residence
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  • Moving to a new ZIP code
  • Moving for work, including seasonal work
  • Moving for college
Other qualifying events
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  • Change in income
  • Becoming a U.S. citizen - for marketplace plans only
  • Getting out of prison

Get covered

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 direct plans


    You can also buy health insurance plans directly from Highmark. These plans don’t offer financial help, but you’ll find additional plans here.

Questions about Special Enrollments Periods?

We're happy to help. Give a Highmark representative a call at 855-856-0316.