Special Enrollment Periods

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What is a Special Enrollment Period (SEP)?

Certain life circumstances can cause an individual or family to need to sign up for a health insurance plan outside of the normal, annual, open-enrollment period (OEP). If these circumstances meet the correct criteria to allow them to enroll, they are known as Qualifying Live Events (QLE). Anyone who has experienced one of these events has a window of opportunity called a Special Enrollment Period (SEP) to sign up for a new plan. To learn more about what kinds of circumstance qualify, read Qualifying Life Events Explained.

When Can I Enroll During a Special Enrollment Period?

The Special Enrollment Period is determined by the type of qualifying life event. In most cases, you will have 60 days after the qualifying life event to enroll in or make changes to a health plan.

Certain life events, like moving into the AmeriHealth New Jersey coverage area, allows you to apply for a health plan up to 60 days before a qualifying life event. If you are losing health care coverage provided by an employer, you will have up to 60 days before and after this qualifying life event to enroll in a health plan.

When you apply for a Special Enrollment Period for the following qualifying life events, you will be sent an Eligibility Notice for Coverage.

  • Loss of minimum essential coverage
  • Change in primary place of living (“permanent move”)
  • Birth
  • Gaining a dependent through adoption, placement for adoption, placement in foster care, or a child support or other court order
  • Marriage

This notice will include a list of acceptable documents you may provide to prove your eligibility for the Special Enrollment Period. Please provide these documents by the deadline listed in the notice to avoid disruptions to your health care coverage. You must send the documents before you can start using your health care coverage. You can preview the Eligibility Notice (under “Special Enrollment Periods”). Learn more at Get Covered New Jersey.

Expanded Access SEP
Under the American Rescue Plan, an SEP is now available for New Jersey residents with income levels between 138% — 200% of the federal poverty level (FPL). For reference, please see the chart below to see if you qualify.
Who needs coverage? What is the income for those covered under the health plan?
Single person $17,774.40 – $25,760.00
Family of 2 $24,039.60 – $34,840.00
Family of 3 $30,304.80 – $43,920.00
Family of 4 $36,570.00 – $53,000.00
Family of 5 $42,835.20 – $62,080.00
Family of 6 $49,100.40 – $71,160.00
Family of 7 $55,365.60 – $80,240.00
Family of 8 $61,630.80 – $89,320.00

See if you qualify.

How To Apply During a Special Enrollment Period

  • If you have questions regarding choosing a health plan or enrolling in a health plan, call AmeriHealth New Jersey at 877-744-5422
  • If you are eligible for financial assistance, please visit the Health Insurance Marketplace.