Special Enrollment Period

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Special Enrollment Periods (SEP) allow for health insurance coverage enrollment any time during the year. Did you miss the opportunity to enroll in a Qualified Health Plan through Nevada Health Link? Although the deadline to enroll in coverage ended on Dec. 15th, you or a loved one may be eligible to enroll now if you report a life or income change.

When Your Life Changes, Your Health Coverage Could Too

Once you sign up for coverage through Nevada Health Link, you must report any life and income changes. This will ensure you continue to receive the correct coverage and savings for you and your family.

  • If your income goes up or you lose a member of your household, you may qualify for less savings than you’re getting now. If you don’t report these changes, you could wind up having to pay back the difference when you file your federal tax return for the coverage year.
  • If you were enrolled in health insurance coverage outside of Nevada Health Link (“off Exchange”) and your income has decreased making you newly eligible for advanced premium tax credits. You may qualify for a special enrollment period (SEP) to enroll in lower cost health insurance through Nevada Health Link.
  • If your income goes down or your gain a household member, you could qualify for more savings than you’re getting now. This could reduce the amount you pay in monthly premiums. You could also qualify for Medicaid or CHIP coverage.

Life changes include:

Loss of health coverage:

You or anyone in your household lost qualifying health coverage. Some examples include:

  • Coverage through a job, or through another’s person’s job. This also applies if you’re now eligible for help paying for Nevada Health Link coverage because your employer stops offering coverage or the coverage is no longer considered qualifying coverage.
  • Losing eligibility for Medicaid or NV Check Up (child ages off of Children’s Health Insurance Program CHIP)
  • Losing eligibility for Medicare
  • Individual or group health plan coverage that ends during the year
  • Coverage under your parent’s health plan (if you’re on it). If you turn 26 and lose coverage, you may qualify for Special Enrollment Period

Note for ALL LIFE CHANGES: This Special Enrollment Period doesn’t include loss of coverage because you didn’t pay your premiums or if your coverage was taken away because of fraud or intentional misrepresentation. You may report a loss of qualifying health coverage up to 60 days before the loss of coverage.
Important, applies for ALL LIFE CHANGES: If you’re enrolling in Marketplace coverage for the first time, you may need to submit documents to confirm that you qualify for this Special Enrollment Period.

Change in household size:

  • Got married
  • Got divorced or legally separated and lost health insurance.
  • Had a baby, adopted a child, or placed a child for foster care or adoption

Note: If you gained or became a dependent due to marriage, one spouse must have also had qualifying health coverage for one or more days in the 60 days prior to the marriage. This does not apply if the spouse:

  • Was living in a foreign country or a U.S. territory for one or more days in the 60 days prior to the marriage.
  • Is a member of a federally recognized tribe or a shareholder in an Alaska Native Corporation.
  • Lived for one or more days during the 60 days before their move or during their most recent enrollment period in a service area where they couldn’t get qualifying health coverage through the Marketplace.

Change your place of residence – moving:

You or anyone in your household had a change in your primary place of living and gain access to a qualified health plan. Household moves that qualify you for a SEP include:

  • Moving to a new home in a new zip code or county
  • Moving to U.S. from a foreign country or U.S. territory
  • Moving to or from the place you attend school
  • Moving to or from the place of your seasonal employment
  • Moving to or from a shelter or other transitional housing

Note: Moving only for medical treatment or staying somewhere for vacation does not qualify you for a SEP. You qualify for SEP only if you had qualifying health coverage for one or more days in the 60 days prior to your move. This does not apply if:

  • You were living in a foreign country or a U.S. territory for one or more days in the 60 days prior to the move.
  • You are a member of a federally recognized tribe or a shareholder in an Alaska Native Corporation.
  • You lived for one or more days during the 60 days before your move or during your most recent enrollment period in a service area where you couldn’t get qualifying coverage through Nevada Health Link.

Important: You must confirm you had qualifying health coverage for one or more days during the 60 days before your move by possibly having to submit documentation.

Other Qualifying Life Events include, and other changes to report:

  • Experience a change in disability status
  • Gaining U.S. Legal Status
  • Experience other changes that may affect your income and household size
  • Change of citizenship or immigration status
  • Incarceration or release from incarceration
  • Change in status as an American Indian/Alaska Native or tribal status
  • Correction to name, date of birth, or social security number

Important: When you apply, you must attest that the information you provide on the application is true, including the facts that qualify you for a Special Enrollment Period.
For more information: visit the FAQs on SEPs on the State Based Exchange platform.

Having experienced domestic abuse/violence or spousal abandonment

You’re a survivor of domestic abuse/violence or spousal abandonment and want to enroll in your own health plan separate from your abuser or abandoner. You can enroll by contacting the Call Center at 1-800-547-2927. Your dependents may be eligible too.

If you’re married to your abuser/abandoner, you can answer on your application that you’re unmarried, without fear of penalty for mis-stating your marital status. You then become eligible for a premium tax credit and other savings on a Nevada Health Link plan, if you qualify based on your income.

If you qualify for this SEP, you’ll have 60 days to enroll in a plan.

Prevailing on an appeal

You believe you received an incorrect eligibility determination or an incorrect coverage effective date and file an appeal with the Exchange. If the ruling goes in your favor, you’ll be given the option to enroll in or change plans either retroactively or prospectively.

When to report changes:

You should report these changes as soon after the change occurs as possible.

If these changes qualify you for a Special Enrollment Period to change plans, in most cases you may have up to 60 days from the life event to enroll in new coverage. If the changes qualify you for more or less savings, it’s important to make adjustments as soon as possible.

How to report changes:

  • See if you qualify for a Special Enrollment Period due to a life event like the life changes listed above and contact Nevada Health Link as soon as possible.
  • Contact Nevada Health Link by calling: 1-800-547-2927; email us at: CustomerServiceNVHL@exchange.nv.gov
  • Important: Do not report these changes by mail.
  • If you become eligible for a plan change mid-year due to a life event change be sure to consider the impact that variations in the new plan will have.
  • Learn more about changing plans and how to report life changes for SEP by visiting our FAQ page.

Steps to report changes in your Nevada Health Link account online: 

  1. Log into your Nevada Health Link account and click “Edit Application.”
  2. The life change must be within 60 days of the current date to gain coverage during a Special Enrollment Period.
  3. Follow instructions on the screen to complete the application process. At the end of the application, you will click “Confirm Event and Finalize Plans.”Some qualifying life events will require you to submit documentation. If this is the case, you’ll receive a notification in your secure inbox.

 

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