Individual SEPs for Adding a Dependent

February 10, 2017

Under our enrollment cap, individual plan members may qualify for a special enrollment period (SEP) that lets them add a dependent to an existing plan.

This for current individual plan members only. We are not accepting new individual plan members, and no plan changes, other than those listed below, will be allowed.

Members on Marketplace plans with an SEP-qualified dependent will need to request the SEP through the Marketplace. Contact the Marketplace with any questions.

Direct plan members must submit an application to Health Alliance. The application must be received within 60 days of the qualifying event. The effective date is determined by the qualifying event. Contact your client consultant with any questions.

Subscribers may qualify for an SEP to add a dependent if:

Their income or household status changes, which can change how much government help they get.
Their dependent is gaining citizenship.
They’re getting married or entering a civil-union partnership.
Their dependent is losing coverage.
They’re having a baby or adopting.
Having a child placed with them through a court order. (Subscribers can only add the dependent with the SEP; they cannot add all dependents.)

Here’s how we will handle the following situations under our enrollment cap:

Situation 1

2 spouses are on 1 policy. The wife, who is the subscriber, divorces her husband, moves to a Medicare plan, or passes away. The policy has to be changed to make the husband the subscriber.

In the event of death, divorce, or Medicare, we will allow the dependent spouse to continue with their coverage.

Situation 2

The son of a subscriber turns 26 and has to transition from being a dependent on his parents’ policy to having his own policy.

A child dependent will be termed on the last day of the month in which he turns 26 years old, but he can complete the process to be authorized as a subscriber on his own policy. It must be the same plan he was previously on.

Situation 3

A military subscriber goes on active duty and her policy is terminated. Once active duty ends, she wants to come back on her Health Alliance individual plan.

We will not allow the military subscriber to re-enroll if there is a break in coverage.