SPECIAL ENROLLMENT PERIOD

You have two set times each year to buy a Blue Cross and Blue Shield of Texas(BCBSTX) health plan. One is the Open Enrollment Period (OEP). This is most often November 1 – December 15 and is the time when everyone can buy a health plan. The other is called the Special Enrollment Period (SEP). The SEP runs from the time the OEP ends until it starts again the next year.

In order to qualify for SEP, you must have had a qualifying life event within the past 60 days. Get more important information before applying for SEP.

IMPORTANT INFORMATION WHEN APPLYING

Deadlines

In most cases, you have 60 days (including weekends and holidays) from the date of your qualifying life event to buy a new health plan.

Some qualifying events, like losing health care coverage due to job loss, may let you buy a plan up to 60 days before your event happens. You can call us at 1-800-538-8833 with any questions.

Documentation

To apply during SEP, you'll need to send in proof showing you had a qualifying life event. These documents will need to show what the life event was and the date the event happened. Marriage or adoption certificates are good examples. View a full list of required documents .

Financial Help

You can check to see if you qualify for a subsidy, also known as a premium tax credit, while applying during SEP. This credit may help you lower the amount you’ll pay for your monthly premium bill.

SEP QUALIFYING LIFE EVENTS

There are many kinds of life events that qualify for a special enrollment.

Major life changes:

• You move to a new area that provides you different plans or isn't covered by your HMO network
• You get married
• You have or adopt a child or gain a dependent through a court-order
• You are no longer covered on a family member's policy because you turned 26
• You have legally separated from or divorced your spouse
• The policy holder passed away

Employment or Financial changes:

• You lose other health coverage due to job loss, a decrease in work hours, end of COBRA coverage or other reasons¹
• Your income or household status changes
• Your employer offered to help with the cost of coverage (through an ICHRA or QSEHRA)

Other Qualifying events:

• Your current health care coverage is ending on a date other than December 31st of the current plan year
• You become a U.S. citizen²
• You can prove that your health insurance company violated its contract with you
• You become a member of an American Indian and Alaska Native tribe²
• You experience an error or other issue when trying to enroll

View a full list of qualifying events .

Not All Life Events Qualify

Not all major life events will qualify you for an SEP.

Non-qualifying events may be:

You can always call us at 1-800-538-8833 or use the contact form if you have questions or need help.

APPLYING DURING SEP

If your life event qualifies you to get health care coverage in a special enrollment, you have three ways to buy your plan:

• Online - You can buy your health plan on our website
• Phone - Call 1-866-514-8044 to speak with a BCBSTX licensed sales representative
• Agent – Work with an independent, authorized agent to sign you up

While your application is being reviewed, we’ll send you a letter if more documentation is needed. You’ll have 30 days from this letter’s date to reply.

COVERAGE START DATES AND PAYMENT

When you buy or change your health plan during the SEP, your health care coverage may not start right away. Your coverage start date is most often based on:

• Your qualifying life event and your event date
• The date you apply
• Making your first payment

IF YOU DON’T QUALIFY

If you can’t get health care coverage during SEP, you may still have options.

You may qualify for Medicaid , Children’s Health Insurance Program (CHIP) or other assistance based on your income. These health care coverage options are provided by the government. There’s no SEP, so you can apply at any time. You may also qualify for financial help.

Note: Members of American Indian and Alaska Native tribes can apply for health care coverage any month of the year.

¹Please note that the following are not considered loss of coverage: voluntarily canceling your health insurance plan, having your plan canceled because you did not pay your premiums or because your plan did not meet the requirements set by the Affordable Care Act for Minimum Essential Coverage.

²Only for health plans bought on the Marketplace.

³BCBSTX does not offer temporary or short-term plans. These plans may not provide the full benefits of a BCBSTX health plan, including essential health benefits.