FLASH: Individual Special Enrollment Period Verification

Starting July 1, 2017, documentation will be required for all qualifying events that allow members on individual plans to add a new dependent during a Special Enrollment Period (SEP).

We will verify SEPs for members on direct and transitional plans starting July 1, and the Marketplace will handle verification for members on Marketplace plans with a phased approach. Overall, we receive a larger volume of membership through the Marketplace plans, which will be subject to government enforcement and management of SEP’s.

In our verification process, current members will have to include documentation with their dependent’s application.

If that’s not included, we’ll send a letter asking for the required info within 30 days or the end of the SEP, whichever is later. If we don’t receive the documentation within that time, their application will be denied.

If you have any questions, contact your provider relations specialist.