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.
Get Your BCBSTX Health Plan
If you qualify for SEP, take a look at the health plans in your area.
Important Information About SEP
Here are some important things to know before buying your 2021 BCBSTX Individual health plan.
Health Plan Effective Dates
- Your BCBSTX plan’s effective date will automatically be the first of the month following the month you select your plan:
- Example 1: If you buy your health plan between May 15 - May 31, 2021, your effective date will be June 1, 2021.
- Example 2: If you buy your health plan between June 1 - June 30, 2021, your effective date will be July 1, 2021.
- Example 3: If you buy your health plan between July 1 - July 31, 2021, your effective date will be August 1, 2021.
If you have a 2021 BCBSTX health plan, you may have begun paying out-of-pocket costs. If you buy a new BCBSTX health plan, this amount you’ve paid may count toward your new plan’s deductible.
To qualify, your health plan must have started within 30 days of when your current coverage ends.
If you have questions, please call the number on the back of your member ID card. You can also ask your independent licensed agent for more information.
Note: If you already have a BCBSTX health plan and have a qualifying life event, such as birth of a child, you can still make changes to your current plan. You’ll need to apply and provide proof of the qualified life event’s date. A birth certificate is a good example. View a full list of required documents.
You May Qualify for a Subsidy
Health care coverage may be more affordable than you think.
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 Event
There are many kinds of life events that may qualify you for special enrollment.
Major life changes:
- You have or adopt a child or gain a dependent through a court-order
- The policy holder passed away
- You move to a new area that provides you different plans or isn't covered by your HMO network
- You get married
- You are no longer covered on a family member's policy because you turned 26
- You have legally separated from or divorced your spouse
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 SEP.
Non-qualifying events may be:
- Choosing not to get health care coverage from your job
- Travel insurance expiring
- Loss of a short-term or temporary health plan3
- Gaining voluntary guardianship of a dependent (not authorized by a court)
- Choosing to cancel your health plan before its renewal or end date
- Loss of State or Federal health care coverage or assistance due to not supplying needed documents as proof
- Ending participation in a Medical Cost Sharing Group
You can always call us at 1-888-697-0683 or use the contact form if you have questions or need help.
Applying During SEP
You have three ways to buy your plan during this new SEP
- Online - You can buy your health plan on our website
- Phone - Call 1-888-731-0406 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.
Other Health Care Coverage Options
You may also 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.
Get Your BCBSTX Health Plan
Take a look at the health care plans in your area.
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.