In what scenario would a member trigger a Special Enrollment Period?

A Special Enrollment Period (SEP) is a designated time frame that allows individuals to enroll in or change their health insurance plans outside of the regular open enrollment period due to certain qualifying life events. Losing Medicaid eligibility is a significant event that triggers an SEP. When a member loses their Medicaid coverage, they face a change in their circumstances that often necessitates finding alternative insurance coverage. This allows them to enroll in a different health plan to ensure they remain protected under a healthcare policy.

In comparison, while moving to a new state can also trigger an SEP, it is not as directly tied to the loss of previous coverage as the loss of Medicaid eligibility. The ending of a current plan may prompt a member to seek new options, yet it does not qualify for a Special Enrollment Period unless accompanied by other significant life changes. Annual enrollment periods are set times each year when all individuals can enroll or make changes to their health coverage but do not pertain to Special Enrollment Periods specifically triggered by qualifying life events.