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Special Enrollment Events

If you would like to enroll on a specific date and none of the options displayed here apply to your situation, please call:


Talk to an agent by calling:
In Western Pennsylvania: 1-855-329-1760

In Central Pennsylvania: 1-855-329-1761

In Northeastern Pennsylvania: 1-855-856-0317

In Delaware: 1-855-329-1764

In West Virginia: 1-855-329-1763

TTY: 711
If you have a technical question about this website, please call 1-800-294-9568.

 

Life Changes

Find out more about special enrollment

You can see more details about the life events that may apply to you.
Just expand each section.



Family or Household Changes

This could be you if you recently got married, entered into a domestic partnership, or had a change in number of child dependents. You may be able change your coverage as a result.

Your situation: You added a dependent to your household. Qualifying events include birth, adoption, placement for adoption, placement in foster care or through a child support order or court order.

Apply no later than: 60 days since the dependent was added to your family.

Coverage starts: The day of the event or the first day of the month following the event. *
Note: (With regard to a child support order or other court order). The Marketplace allows a Qualified Individual/Enrollee to elect a coverage effective date pursuant to the 15th of the month rules.

Your situation: You married or entered into a domestic partnership. You either added a dependent, such as your spouse or partner, or became a dependent on someone else's plan.

Apply no later than: 60 days since the marriage or entering into the domestic partnership.

Coverage starts: 1st day of the following month.*

Job, Income or Residence Changes

This could be you if you recently moved, had a job change or reduction in hours that resulted in loss of minimum essential coverage, or lost eligibility for tax credits. Your health plan options may now be different because of this change.

Your situation: You or anyone in your household will newly gain access to an Individual Coverage Health Reimbursement Arrangement or will be newly provided with a qualifying Small Employer Health Reimbursement Arrangement.

Apply no later than: 60 days since your benefit options changed

Coverage starts: First day of the following month*

Your situation: Your change in income, household or other status affects your eligibility for cost savings. This includes Advanced Premium Tax Credits (APTCs) and Cost-Sharing Reductions (CSRs). Changes in APTC amount do not apply. Must currently be enrolled in a qualified health plan.

Apply no later than: 60 days since your income changed.

Coverage starts: If the plan selection is between the 1st and the 15th of the month, your coveragewill start as soon as the 1st day of the following month. If the plan selection is between the 16th and the end of the month, your coverage will start the 1st day of the second month.*

Your situation: Your former employer provided you with coverage. You no longer work at the company that provided your plan. Or, your company's plancovered you, but you had your hours reduced. As a result, you are no longereligible for coverage.

Apply no later than: 60 days before or after you lose coverage.

Coverage starts: First day of the following month.*

Your situation: Your spouse/domestic partner's former employer provided you with coverage. He or she no longer works at the company that provided yourplan. Or, his/her company's plan provided overage for you, but he or she had hours reduced. As a result, you are no longer eligible for coverage.

Apply no later than: 60 days before or after you lose coverage.

Coverage starts: First day of the following month.*

Your situation: Your spouse/domestic partner's employer provided you with coverage. He or she has switched to a Medicare plan.

Apply no later than: 60 days before or after you lose coverage.

Coverage starts: First day of the following month.*

Your situation: You permanently moved. The plans available to you at your new residence differ from your former residence.

Apply no later than: 60 days from when you moved.

Coverage starts: If your application is received between the 1st and 15th of the month, your coverage will start the first day of the following month. If your application is received between the 16th and end of the month, your coverage will start the first day of the second month.*

Loss, Issues or Changes with your Insurance

This could be you if you lost minimum essential coverage. Your insurance options may have changed because of a death, divorce, eligibility or other change in coverage status.

Your situation: Loss of coverage can happen for a number of reasons. You may lose job-based health coverage, either your own or as a result of a death or divorce. You may age out of a parent's plan at age 26.  You could become ineligible for Medicaid or CHIP.  You may have an expiration of COBRA coverage or non-calendar year policy.  Or losing pregnancy related or medically needy coverage under Medicaid. These reasons and others like it could qualify you for a special enrollment period.

Apply no later than: 60 days before or after you lose coverage.

Coverage starts: Notification can be 60 days prior to and 60 days after the loss of coverage.

If plan selection is before or on the date of loss of coverage, the effective date is the first day of the month following the loss of coverage. If plan selection is after the loss of coverage the effective date is the first day of the month following the plan selection.*

Note: You are not eligible for an SEP if you voluntarily drop: a job-based plan without leaving your job; an individual insurance plan, unexpired COBRA coverage; or any plan that doesn't qualify as minimum essential coverage.

Your situation: Your health insurance policy that covered minimum essential health benefits expired outside of the standard January - December calendar year.

Apply no later than: 60 days before or after you lose coverage.

Coverage starts: First day of the following month if you apply for a product through Highmark.*

Your situation: Your spouse/domestic partner provided you with coverage. You legally separated or divorced, or your spouse/domestic partner died. As a result, you are no longer eligible for coverage. This may also pertain to you if you are no longer eligible to be on your parent's plan.

Apply no later than: 60 days before or after you lose coverage.

Coverage starts: Notification can be 60 days prior to and 60 days after the loss of coverage.

If plan selection is before or on the date of loss of coverage, the effective date is the first day of the month following the loss of coverage. If plan selection is after the loss of coverage the effective date is the first day of the month following the plan selection.*

Note: This is an extremely rare situation. Immediately contact your health insurance provider or the Health Insurance Marketplace.

Your situation: You did not register during open enrollment due to a factor outside of your control. This is called an "Exceptional Circumstance." One potential example of an "Exceptional Circumstance" is that you were in the hospital long-term during the open enrollment period. Another example would be if your region was a state-or federally-declared disaster region. These are two of many example situations.

Whether you can reapply (or apply) is determined by the Health Insurance Marketplace. Also, this only pertains to plans purchased through the Health Insurance Marketplace.

Coverage starts: Coverage effective date will be determined by the Health Insurance Marketplace.

Note: This is an extremely rare situation. If you think there was a problem with your enrollment, immediately contact your health insurance provider or the Health Insurance Marketplace.

Your situation: There was a problem when you signed up for-or tried to sign up for-a plan.

Whether you can reapply (or apply) is determined by the Health Insurance Marketplace.

Coverage starts: Coverage effective date will be determined by the Health Insurance Marketplace.

Note: This is an extremely rare situation. If you think there is an error in your coverage, immediately contact your health insurance provider or the Health Insurance Marketplace.

Your situation: You think there is an inconsistency between the coverage you purchased and the way that your insurance plan is administered.

Whether you can reapply is determined by the Health Insurance Marketplace.

Coverage starts: Coverage effective date will be determined by the Health Insurance Marketplace.

American Indian, Alaska Native, or Changes in Citizenship

This could be you if you recently became a U.S. citizen, national or lawfully present. Or, if you are part of a federally-recognized tribe, you can sign up for coverage at any time. Coverage not available through the Highmark site.

Your situation: You are an American Indian or Alaska Native. You are part of a federally-recognized tribe. You may sign up for new coverage on the Health Insurance Marketplace at any time.

You can also change the coverage that you already purchased on the Marketplace. You can do this once a month.

Please note: all other Special Enrollment Period situations apply to American Indians and Alaska Natives.

Coverage starts: Based on applicable laws defined by the Health Insurance Marketplace.

Your situation: You became a U.S. citizen, national or lawfully present. This change allows you to sign up for new coverage on the Health Insurance Marketplace.

Apply no later than: 60 days since your immigration status changed.

Coverage starts: Based on applicable laws defined by the Health Insurance Marketplace.

Returned from Active Military Service or were released from Incarceration

Your situation: Your change in Military Status may qualify you for coverage.

Apply no later than: 60 days since the event.

Coverage starts:  Standard enrollment effective dates apply to this SEP based upon receipt of required forms and documentation. If your application is received between the 1st and 15th of the month, coverage will start as soon as the 1st day of the following month. If your application is received between the 16th and end of the month, coverage will start the 1st day of the second month.

Note:  Application submission cannot be prior to the occurrence of the event. Samples of documentation are supporting paperwork confirming departure date from active military service. You don’t need to provide proof of prior coverage for this SEP reason.

Your situation: Your release from Incarceration may qualify you for coverage.

Apply no later than: 60 days since the event.

Coverage starts:  Standard enrollment effective dates apply to this SEP based upon receipt of required forms and documentation. If your application is received between the 1st and 15th of the month, coverage will start as soon as the 1st day of the following month. If your application is received between the 16th and end of the month, coverage will start the 1st day of the second month.

Note:  Application submission cannot be prior to the occurrence of the event. Samples of documentation would be a prison release form. You don’t need to provide proof of prior coverage for this SEP reason.

*Coverage is effective only after you have successfully submitted your complete application, provided any necessary documents, and you've made your initial payment. Instructions for your initial payment will be given once you've completed and submitted your application. If you qualify for a Special Enrollment Period, the start date for your coverage cannot be prior to the occurrence of the qualifying life event.