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Special Enrollment Periods

Special Enrollment Periods (SEPs)

Consumers must enroll in coverage on Georgia Access for the upcoming calendar year during Open Enrollment. However, if you have a change in circumstance mid-year, you may be eligible to enroll in coverage or modify your coverage on Georgia Access through a Special Enrollment Period (SEP).

Qualifying Life Events (QLEs)

You are eligible for an SEP if you experience one of the following circumstances, known as Qualifying Life Events (QLEs), in the last 60 days:

  • Birth of a child.
  • Adoption.
  • Court-appointed dependent.
  • Pregnancy.
  • Marriage.
  • Finalize a divorce (resulting in loss of coverage).
  • Gain U.S. citizenship, legal presence, or refugee status.
  • Are released from incarceration.
  • The primary person who files household taxes is incarcerated.
  • Lose employer healthcare coverage (through self or spousal equivalent).
  • Lose government health care coverage (e.g., Medicare, Medicaid, PeachCare for Kids®, TRICARE, or Peace Corps coverage).
  • Exhaust Consolidated Omnibus Budget Reconciliation Act (COBRA) coverage.
  • Death of a household member.
  • Move to Georgia.
  • Move to a new county or zip code in Georgia.
  • The individual in the household who paid for premiums or whose employment provided coverage moved out of state.
  • Your employer offers an Individual Coverage Health Reimbursement Arrangement (ICHRA).
  • Your employers offers a Qualified Small Employer Health Reimbursement Arrangement (QSEHRA).
  • Your Georgia Access plan is discontinued.
  • You turn 26 and are no longer covered by parent or guardian’s insurance plan.
  • Experience domestic violence (and want to enroll in a separate health plan from the perpetrator).

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.
  • Other special circumstances.

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 771).