Special Enrollment Period Grid by State

Illinois Wisconsin Special Enrollment Period Grid and Wisconsin

SEP Event Window to Apply Off Exchange On Exchange Documentation Needed for Verification Effective Date Effective Date

Loss of Coverage due to: 60 days before or 60 If plan selection is If plan selection is • A letter or bill from an insurance company stating the • Termination of employment days after the date of made on or before the made on or before the date coverage ended or will end. • End of dependent status loss of coverage date of the event: date of the event: • A letter from an employer stating the date coverage • Legal separation or divorce • 1st of the month • 1st of the month ended or will end or the employer will stop • Reduction in hours of employment required to Note: Member may following the date of following the date of contributing towards coverage. maintain employer-sponsored coverage choose COBRA and if the event the event • A letter from a former employer offering COBRA • Termination of employer contributions on an within their 60- day coverage with the date this coverage would start; or employer-sponsored plan SEP window they may If plan selection is If plan selection is showing your COBRA coverage ended or will end; or • Reaching lifetime limits of all benefits in a voluntarily term their made after the date of made after the date of your employer stopped or will stop contributing to the grandfathered plan COBRA plan and select the event: the event: cost of coverage and when. • Exhaustion of COBRA a different plan (On or • 1st of the month • 1st of the month • A letter or notice from a government health program • Termination of /CHIP Off the Exchange) following plan following plan (e.g., (, Medicaid, TRICARE, CHIP) stating the • Off-calendar year policy expires selection selection date coverage ended or will end. • Loss of pregnancy-related coverage • Loss of medically needy coverage (AmeriCorps, Indian For a complete list of documents, visit: Health Service, student health coverage, etc.) healthcare.gov/help/prove-coverage-loss • Termination/change in employer contributions on an employer-sponsored plan (including COBRA)

Loss of Coverage due to: 60 days after the date 1st of the month 1st of the month See list above • Death of an enrollee which ends eligibility for covered of death following plan following plan dependents selection selection

Permanent Move & Gaining Access to Additional Plan Off Exchange: If plan selection is Regular 15th of the • U.S. Postal Service change of address confirmation Offerings (Inside the U.S.) • 60 days before or 60 made on or before the month rule letter showing both previous and new address. days after the date date of the move: • Mortgage or rental document that shows a new Note: Members must also prove they had minimum of the move • 1st of the month residential address and occupancy date. essential coverage for at least one day within the 60 following the date of • Bills or financial statements that show a change of days before the move. the event address or newly started services at your new address. On Exchange: • Letter from government organization on official • 60 days after the If plan selection is letterhead, showing the change of address (e.g., Social date of the move made after the date of Security Statement, a notice from SNAP (food stamps) the move: or TANF (cash assistance) agency, mail from the • Regular 15th of the Department of Motor Vehicles, IRS, or voter month rule registration card).

For a complete list of documents visit: healthcare.gov/help/prove-move

QA01435 (1120) Illinois and Wisconsin Page 1 of 4

SEP Event Window to Apply Off Exchange On Exchange Documentation Needed for Verification Effective Date Effective Date

Permanent Move & Gaining Access to Additional Plan Off Exchange: If plan selection is Regular 15th of the If you moved to the U.S. from abroad or from a U.S. Offerings from outside the U.S. • 60 days before or 60 made on or before the month rule territory, you will need to prove that you lived outside days after the date date of the move: the U.S. when you send documents proving your move Note: Members living abroad and of the move • 1st of the month and move date. Make sure to include a document moving to the U.S. do not need to prove prior coverage. following the date of showing that your old address was outside the U.S. On Exchange: the event • 60 days after the date of the move If plan selection is made after the date of the move: • Regular 15th of the month rule

Gaining a Dependent Through: Birth, Adoption, 60 days after the date Choice of: Choice of: • Birth certificate Placement for Adoption, or Foster Care of the event • Date of the event • Date of the event • Copy of adoption papers • 1st of the month • 1st of the month Note: Existing members can only choose to add the following the date of following the date of dependent to existing coverage (same plan) or if not the event the event allowed by issuer business rules, another plan within the • Regular 15th of the • Regular 15th of the same metal tier. month rule month rule

A consumer can also choose to enroll a dependent in a child-only policy at any metal tier.

Gaining a Dependent Through: Child Support or Other 60 days after the date Choice of: Choice of: • Copy of the court order Court Order of the order • Date of the court • Date of the court order order • Regular 15th of the • Regular 15th of the month rule month rule

Marriage 60 days after the date • 1st of the month • 1st of the month • Copy of marriage certificate Note: Applicants must prove that at least one spouse held of marriage following plan following plan AND minimum essential coverage for at least one day within selection selection • A letter from an insurance company, a copy of an ID the 60 days before the marriage. card, or contact information for the insurance company so Quartz can verify minimum essential coverage. Existing members can only choose to add a spouse to existing coverage (same plan) or if not allowed by issuer business rules, another plan within the same metal tier.

Gaining Status as a Citizen, National, or Lawfully Present 60 days after the date N/A Regular 15th of the Citizen: Individual of the event month rule • Copy of naturalization papers

Legal resident: • Copy of a green card, educational certificate, or visa

QA01435 (1120) Illinois and Wisconsin Page 2 of 4

SEP Event Window to Apply Off Exchange On Exchange Documentation Needed for Verification Effective Date Effective Date

Release from Incarceration 60 days after the date Regular 15th of the Regular 15th of the Copy of documentation from an attorney, correctional of release month rule month rule facility, or probation officer of the date you are no longer incarcerated.

Member of Federally Recognized Tribe Members of Federally N/A Regular 15th of the Recognized Tribe can month rule apply for coverage or change coverage once per month

Change in Income that Results in Becoming Newly 60 days after the date N/A Regular 15th of the Eligible or Ineligible for APTCs or CSR Plans of the change in month rule income Note: Only available to members with existing Marketplace Coverage

Circumstances such as: 60 days after SEP Regular 15th of the Regular 15th of the • Enrollment Errors by HHS, the Marketplace, or a non- eligibility has been month rule month rule or retro or exchange entity determined accelerated effective • QHP violates its contract date as determined by • Domestic Abuse & Spousal Abandonment the Marketplace

Exceptional Circumstances such as: 60 days after SEP N/A Regular 15th of the • Other events as determined by the Marketplace Eligibility has been month rule or retro or determined accelerated effective date as determined by the Marketplace

Newly Eligible for an Individual Coverage Health 60 days before or 60 If plan selection is If plan selection is Complete an attestation stating you’re newly eligible for Reimbursement Arrangement (ICHRA) or Qualified days after the date of made on or before the made on or before the an ICHRA or QSEHRA Small Employer Health Reimbursement Arrangement eligibility of ICHRA or date of the event: date of the event: (QSEHRA) QSEHRA • 1st of the month • 1st of the month following the date of following the date of the event the event

If plan selection is If plan selection is made after the date of made after the date of the event: the event: • 1st of the month • 1st of the month following plan following plan selection selection

QA01435 (1120) Illinois and Wisconsin Page 3 of 4

Regular 15th of the month rule: . Plan selection between the 1st and the 15th of the month provides a 1st of the next month effective date. . Plan selection between the 16th and end of the month provides a 1st of the following (2nd) month effective date. Loss of coverage does not include termination due to failure to pay premiums or voluntary termination (including COBRA) Quartz Direct Enrollment will not support SEP Enrollments for Marketplace members. Marketplace members will be directed to the Marketplace. Eligibility and effective dates for members applying through the Marketplace will always be determined by the Marketplace.

QA01435 (1120) Illinois and Wisconsin Page 4 of 4

Special Enrollment Period Grid Minnesota

SEP Event Window to Apply Off Exchange On Exchange Documentation Needed for Verification Effective Date Effective Date

Loss of Coverage due to: 60 days before or 60 If plan selection is 1st of the month • A letter or bill from an insurance company stating the • Termination of employment days after the date of made on or before the following plan date coverage ended or will end. • Loss of employer-sponsored coverage (includes the end loss of coverage date of the event: selection but not • A letter from an employer stating the date coverage of continuation coverage such as COBRA and retiree • 1st of the month before your other ended or will end or the employer will stop coverage) Note: Member may following the date of qualifying health contributing toward coverage. • Reduction in hours of employment required to choose COBRA and if the event coverage ends • A letter from a former employer offering COBRA maintain employer-sponsored coverage within their 60-day SEP coverage with the date this coverage would start; • Termination/change in employer contributions on an window they may If plan selection is showing your COBRA coverage ended or will end; or employer-sponsored plan (including COBRA) voluntarily term their made after the date of your employer stopped or will stop contributing to the • Employer ends your coverage COBRA plan and select the event: cost of coverage and when. • Change to a dependent’s status, such as turning 26 a different plan (On or • 1st of the month • A letter or notice from a government health program years old and losing coverage through a parent’s plan Off the Exchange) following plan stating the date coverage ended or will end (e.g., • End of your non-calendar year plan selection Medicare, Medicaid, TRICARE, CHIP). • Loss of coverage in Medical Assistance (MA) or MinnesotaCare • Loss of other government-sponsored coverage such as most types of TRICARE, pregnancy-related, or medically needy coverage (AmeriCorps, Indian Health Service, student health coverage, etc.) • Reaching lifetime limit of all benefits in a grandfathered plan

Loss of Coverage due to: 60 days from date of Regular 15th of the Regular 15th of the • Court order with the date of divorce or legal separation • Divorce or Legal Separation Divorce or Legal month rule month rule Separation

Loss of Coverage due to: 60 days from date of Choice of: Choice of: • Death certificate • Death of enrollee death • 1st of the month • 1st of the month • Public notice of death (e.g., published obituary) following plan following plan selection selection • Regular 15th of the • Regular 15th of the month rule month rule

QA01435 (1120) Minnesota Page 1 of 5

SEP Event Window to Apply Off Exchange On Exchange Documentation Needed for Verification Effective Date Effective Date

Gaining a Dependent Through: Birth 60 days after the date Choice of: Choice of: • Birth certificate of the event • Date of the event • Date of the event Note: Existing members can only choose to add the • 1st of the month • You may have other dependent to existing coverage (same plan) or if not following the date of options available. allowed by issuer business rules, another plan within the the event Contact MNsure. same metal tier. • Regular 15th of the month rule A consumer can also choose to enroll a dependent in a child-only policy at any metal tier.

Gaining a Dependent Through: Adoption, Foster Care, 60 days after the date Choice of: Choice of: • Birth certificate Child Support or Court Order of the event • Date of event • Date of event • Copy of adoption papers • 1st of the month • You may have other • Copy of court order Note: Existing members can only choose to add the following plan options available. dependent to existing coverage (same plan) or if not selection Contact MNsure. allowed by issuer business rules, another plan within the • Regular 15th of the same metal tier. month rule

A consumer can also choose to enroll a dependent in a child-only policy at any metal tier.

Marriage 60 days after the date • 1st of the month • 1st of the month • Copy of marriage certificate of the marriage following plan following plan AND Note: Applicants must prove that at least one spouse selection selection • A letter from an insurance company, a copy of an ID held minimum essential coverage for at least one day card, or contact information for the insurance company within the 60 days before the marriage. so Quartz can verify minimum essential coverage.

Existing members can only choose to add their spouse to existing coverage (same plan) or if not allowed by issuer business rules, another plan within the same metal tier.

Change in Income that Results in Becoming Newly 60 days from date of • N/A • Regular 15th of the Eligible or Ineligible for APTCs or CSR Plans change in eligibility or month rule determination notice Note: Only available to members with existing Marketplace Coverage

Gain Lawful Presence or Citizenship 60 days after your • N/A • Regular 15th of the See the full list at: status change month rule mnsure.org/new-customers/enrollment- deadlines/special-enrollment/sep- le/citizenship/index.jsp

QA01435 (1120) Minnesota Page 2 of 5

SEP Event Window to Apply Off Exchange On Exchange Documentation Needed for Verification Effective Date Effective Date

Release from Incarceration 60 days after the date • Regular 15th of the • Regular 15th of the • Copy of documentation from an attorney, correctional of release month rule month rule facility, or probation officer of the date you are no longer incarcerated.

Member of Federally Recognized Tribe Members of a N/A Regular 15th of the • Tribal affiliation card Federally Recognized month rule • Tribal affiliation document Tribe can apply for • A certified letter or membership list from the tribe will coverage or change be accepted if the other two forms are not available coverage once per month.

Permanent Move & Gaining Access to Additional Plan On Exchange: 60 days If plan selection is 1st of the month For a full list, visit: Offerings (Inside the U.S.) from date of move made on or before the following plan mnsure.org/new-customers/enrollment- date of the move: selection deadlines/special-enrollment/sep-le/move/index.jsp Note: Members must also prove they had minimum Off Exchange: 60 days • 1st of the month essential coverage for at least one day within the 60 days before or after the following the date of before the move. date of move the event

If plan selection is made after the date of the event: • 1st of the month following plan selection

Permanent Move & Gaining Access to Additional Plan On Exchange: 60 days If plan selection is 1st of the month For a full list, visit: Offerings from outside the U.S. from date of move made on or before the following plan mnsure.org/new-customers/enrollment- date of the move: selection deadlines/special-enrollment/sep-le/move/index.jsp Note: Member’s living abroad and moving to the U.S. do Off Exchange: 60 days • 1st of the month not need to prove prior coverage. before or after the following the date of date of move the event

If plan selection is made after the date of the event: • 1st of the month following plan selection

QA01435 (1120) Minnesota Page 3 of 5

SEP Event Window to Apply Off Exchange On Exchange Documentation Needed for Verification Effective Date Effective Date

Enrolled in Coverage Outside of MNSure and Income 60 days from when N/A Regular 15th of the • Employer notice showing the date the rate of pay was Decreases household income month rule decreased. decreased. If you know • Pay stubs that show a decrease in the hourly wage your income will be amount or hours worked between a previous pay stub decreasing in the near and the most recent pay stub. future, you must wait • If you are self-employed, MNSure will work with you to until the decrease in identify the documents needed to verify the date your income occurs. income decreased.

Be prepared to send verification that you had previous coverage outside of MNSure: • Document from your previous health insurance company showing when your previous coverage ended and that you were enrolled in this coverage for at least one day in the 60 days right before your income decreased

Newly Eligible for an Individual Coverage Health 60 days before or 60 • If you select your • If you select your Off Exchange: Reimbursement Arrangement (ICHRA) or Qualified days after the date of plan before the date plan before the date • Complete an attestation stating you’re newly eligible Small Employer Health Reimbursement Arrangement eligibility of ICHRA or the HRA can take the HRA can take for an ICHRA or QSEHRA (QSEHRA) QSEHRA effect, then your effect, then your coverage starts the coverage starts the On Exchange: first day of the first day of the • An offer for a qualifying HRA that took effect in the month after the date month after the date past 60 days or that will take effect in the next 60 days. the HRA can take the HRA can take • Your name, the HRA type, and the start date of the effect, or if the HRA effect, or if the HRA benefit. takes effect on the takes effect on the first day of a month, first day of a month, then your coverage then your coverage starts the first day starts the first day the HRA can take the HRA can take effect effect • If you select your • If you select your plan on or after the plan on or after the date the HRA can date the HRA can take effect, your take effect, your coverage start date coverage start date is the first day of the is the first day of the next month. next month.

Coverage cannot start Coverage cannot start before your HRA before your HRA benefit begins. benefit begins.

QA01435 (1120) Minnesota Page 4 of 5

SEP Event Window to Apply Off Exchange On Exchange Documentation Needed for Verification Effective Date Effective Date

Special Circumstances: 60 days from the start N/A Regular 15th of the AmeriCorps Service or end of service month rule

Circumstances Beyond Control, Not Eligible for Medical Case by Case N/A Case by Case Assistance after Final Determination

Victim of Domestic Abuse or Spousal Abandonment 60 days from the N/A Regular 15th of the request for SEP due to month rule domestic abuse or spousal abandonment

Enrollment Error 60 days from the date N/A MNsure will work with • Provide documentation from an appropriate regulatory Violation of Qualified Health Plan Terms and Conditions. of which MNsure the insurance agency as determined by MNsure on a case-by-case As an enrollee or a dependent, you may qualify if you determines you qualify company to correct or basis. demonstrate to MNsure a violation of the terms and eliminate the effects conditions of your qualified health plan. of the violation.

Agency Error The date on which N/A MNsure will correct or • Provide documentation from an appropriate regulatory If you believe that inaction or action by MNsure or your MNsure determines eliminate the effects agency as determined by MNsure on a case-by-case navigator or broker caused an error on your enrollment, you qualify. Your SEP of the error, inaction, basis. or caused you to be unable to enroll, then you might be lasts 30 days from that or misconduct, eligible for a special enrollment period (SEP) to enroll or date. including coverage change plans. You have 60 days from when the error options: occurred to report the error to MNsure. • Coverage starts the date coverage would have started without the error, inaction, or misconduct. • Or, the first of the month following plan selection

Regular 15th of the month rule: . Plan selection between the 1st and the 15th of the month allows a 1st of the next month effective date. . Plan selection between the 16th and end of the month gives a 1st of the following (2nd) month effective date. Loss of coverage does not include termination due to failure to pay premiums or voluntary termination (including COBRA) Quartz Direct Enrollment will not support SEP Enrollments for Marketplace members – members will be directed to the Marketplace. Eligibility and effective dates for members applying through the Marketplace will always be determined by the Marketplace.

QA01435 (1120) Minnesota Page 5 of 5