CES Special Enrollment Periods 1 — Questions and Answers
Question 1: A Special Enrollment Period (SEP) is triggered when an individual loses minimum essential coverage. How many days does the person typically have to enroll in a new plan?
- 30 days
- 60 days (Correct answer)
- 90 days
- 120 days
Correct answer: 60 days
Individuals have 60 days before or after the qualifying life event to enroll or change coverage outside of Open Enrollment.
Question 2: Which of the following is a qualifying life event that triggers a Special Enrollment Period?
- Voluntarily canceling your health plan
- Getting married (Correct answer)
- Deciding to switch insurance companies
- Moving within the same coverage area
Correct answer: Getting married
Getting married is a qualifying life event that triggers a 60-day SEP, allowing the newly married individual to enroll in or change health coverage.
Question 3: Having a baby triggers a Special Enrollment Period. The SEP window begins:
- 60 days before the due date
- On the date of birth only
- The day of birth and lasts 60 days (Correct answer)
- 30 days before and 30 days after the birth
Correct answer: The day of birth and lasts 60 days
The birth of a child triggers a 60-day SEP starting from the date of birth, and coverage can be made retroactive to the birth date.
Question 4: When is the annual Open Enrollment Period (OEP) for ACA Marketplace individual and family plans?
- October 1 – December 15
- November 1 – January 15 (Correct answer)
- September 15 – November 30
- December 1 – February 28
Correct answer: November 1 – January 15
The ACA Marketplace Open Enrollment Period runs November 1 through January 15, with coverage starting January 1 for enrollments completed by December 15.
Question 5: An employee who is newly eligible for employer-sponsored coverage has how many days to enroll?
- 15 days
- 30 days (Correct answer)
- 60 days
- 90 days
Correct answer: 30 days
Under HIPAA portability rules, newly eligible employees have at least 30 days to enroll in an employer-sponsored plan when they first become eligible.
Question 6: Moving to a new ZIP code or county that changes available plan options triggers a SEP. The enrollee must provide documentation such as:
- A letter from their old insurance company
- Proof of prior address and new address (Correct answer)
- A doctor's note confirming the move
- Income verification from the new location
Correct answer: Proof of prior address and new address
When claiming a move-based SEP, the Marketplace may require documentation showing the prior and new addresses to verify eligibility.
CES Special Enrollment Periods 1
A Special Enrollment Period (SEP) is triggered when an individual loses minimum essential coverage.
How many days does the person typically have to enroll in a new plan?