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Special Enrollment Periods

Special Enrollment Periods (SEPs)

A Special Enrollment Period (SEP) is a time outside of the yearly Open Enrollment (OE) period when Georgians can enroll in or change health insurance coverage on Georgia Access due to specific life events or changes in circumstance. Depending on the SEP type, consumers have either 60 or 90 days before or after the change occurs to enroll.

Qualifying Life Events (QLEs)

You are eligible for an SEP if you experience one of the following circumstances, known as Qualifying Life Events (QLEs).

You may qualify for an SEP if one or more of changes below happened to you or anyone in your household in the past 60 days.

  • Marriage. Pick a plan by the last day of the month and your coverage can start the first day of the next month.
  • Birth of a child, adoption, court-appointed dependent. Your coverage can start the day of the event, even if you enroll in the plan up to 60 days afterward.
  • Divorce or legal separation and lost health insurance coverage as a result. Divorce or legal separation without losing coverage doesn’t qualify you for an SEP. Your coverage can start the day of the event.

You may qualify for an SEP if you move to:

  • The State of Georgia, a new ZIP code, or county.
  • The U.S. (from a foreign country or United States territory).

Or, if you move to or from the:

  • Place you attend school (if you’re a student).
  • Place you both live and work (if you’re a seasonal worker).
  • Shelter or other transitional housing.

You may qualify for an SEP if the individual in the household who paid for premiums or whose employment provided coverage moved out of state.

You must prove you had qualifying health coverage for one or more days during the 60 days before your move. You don’t need to provide proof if you’re moving from a foreign country or United States territory.

You may qualify for an SEP if:

  • You or anyone in your household gain U.S. citizenship, legal presence, or refugee status.
  • You or anyone in your household are released from incarceration, or the primary person who files household taxes is incarcerated.

You may qualify for an SEP if you or anyone in your household lost qualifying health coverage in the past 60 days or expects to lose coverage in the next 60 days. Examples of this include:

  • You lose employer healthcare coverage (through self or spousal equivalent).
  • You turn 26 and are no longer covered by parent or guardian’s insurance plan.
  • Your Georgia Access plan is discontinued.
  • You lose eligibility for a student health plan.
  • Your individual or group health plan coverage year is ending in the middle of the calendar year, and you choose not to renew it.
  • You lose government health care coverage (e.g., Medicare, Medicaid, PeachCare for Kids®, TRICARE, or Peace Corps coverage). Georgia Access is extending the federal SEP to grant consumers a 90-day SEP for loss of Medicaid/PeachCare for Kids® coverage; a 60-day SEP will be implemented for instances where a consumer was referred for Medicaid determination during OE but is denied Medicaid after the OE period is done.
  • You exhaust Consolidated Omnibus Budget Reconciliation Act (COBRA) coverage.

You are entitled to an SEP if you become eligible for either an Individual Coverage Health Reimbursement Arrangement (ICHRA) or a newly provided Qualified Small Employer Health Reimbursement Arrangement (QSEHRA) from your employer. An ICHRA and a QSEHRA are employer-funded health reimbursement arrangements that are alternatives to group health plans.

These HRAs enable employers to reimburse employees for some or all premium and health expenses. To qualify for a SEP, the employer must meet specific eligibility criteria set forth by the HRA regulations.

Visit Learn More > Eligibility & Employer Insurance for more information.  

You are eligible to enroll through an SEP at any time if you have the following QLEs:

  • Have an estimated annual household income below 150% of the Federal Poverty Level (FPL).
  • Are American Indian/Alaska Native (AI/AN).
  • Other special circumstances, such as experiencing domestic violence, a natural disaster, or serious medical condition.
  • Plan display error by your insurance company or Georgia Access.

How to Apply for an SEP

You can apply for an SEP by using the Georgia Access consumer portal or by enrolling with a certified agent, web broker, or insurance company. You will need to report your QLE and supply supporting documentation with your application. You can also contact the Georgia Access contact center at 888-687-1503 (TTY Line 711).

How to Verify your SEP

When applying for an SEP, consumers must attest the information provided is accurate and submit documentation to verify the QLE, if requested.

Appealing an SEP Decision

If you are denied an SEP, but think you qualify, you can appeal the decision. Visit Learn More > Appeals for more information.

Additional Information

Visit About Georgia Access > Policies for more information on Georgia Access policies that may impact you.