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  • MLCA


•Coverage through a job, or through another person’s job

• Medicaid or Children’s Health Insurance Program (CHIP) coverage (including pregnancy-related coverage and medically needy coverage)

• Medicare

• Individual or group health plan coverage that ends during the year

• Dependent coverage that a consumer has through a parent’s plan. If you turn 26 or the maximum dependent age allowed in your state and lose coverage, you can qualify for an SEP. 2. Change in household size: a consumer may qualify for an SEP if you (or anyone in your household):

• Got married

• Had a baby, adopted a child, or placed a child for foster care

• Got divorced, legally separated, or had a death in the family and lost health coverage

• Gained or became a dependent due to a child support or other court order 3. Change in primary place of living: if you (or anyone in your household) has a change in your primary place of living, such as:

• Moving to a new home in a new zip code or county where new qualified health plans are available

• Moving to the U.S. from a for eign country or United States territory

• A student moving to or from the place he or she attends school

• A seasonal worker moving to or from the place he or she lives and works 4. Change in eligibility for Marketplace coverage or help paying for coverage. If you (or anyone in your household) is enrolled in Marketplace coverage and reports a change that makes the consumer:

• Newly eligible for help paying for coverage

• Ineligible for help paying for coverage

• Eligible for a different amount of help paying out-of-pocket costs Many changes in circumstance or life events can trigger SEPs, but you should understand that not all changes will allow you to enroll in or change plans. Some changes that do not trigger an SEP include:

• Loss of minimum essential coverage due to failure of payments

• Voluntary COBRA cancelation

• Pregnancy (a birth, however, will lead to an SEP)

• Income changes, unless a consumer is currently enrolled in a qualified health plan or their income rose above the 100% Federal Poverty Line

• Loss of coverage for more than 60 days.


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