Issued by: Centers for Medicare & Medicaid Services (CMS)

Issue Date: October 31, 2017

Program Area: Enrollment and Eligibility (ENR)

Question: Under what conditions can an individual apply for health insurance prior to the beginning of the Open Enrollment Period, or where are the answers available in the training guide?

Answer: An individual may elect or change current Qualified Health Plan (QHP) coverage outside of the Open Enrollment Period (OEP) if a Special Enrollment Period (SEP) situation exists. Some examples of qualifying events, which may constitute an SEP are as follows: - Loss of qualifying health coverage - Change in household size - Change in primary place of living - Change in eligibility for Marketplace coverage or help paying for coverage - Enrollment or plan error Additional SEP guidance can be found in the FFM-SHOP Enrollment Manual at https://www.regtap.info/uploads/library/ENR_FFMSHOP_Manual_5CR_080916.pdf or via guidance available in the REGTAP Library at https://www.regtap.info/reg_library.php.

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