Custom AgentBroker Resources
Apr 15, 2024
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What to know about the SEP for government-entity-declared disasters or other emergencies

As a trusted agent for your clients, it’s important to understand the Special Enrollment Period (SEP) available to beneficiaries affected by an emergency or major disaster declared by a Federal, state, or local government. This SEP may apply to an enrollment and a disenrollment election.

An individual is eligible for this SEP provided they comply with all three of these requirements.

  1. Resides at the start of the SEP eligibility period in an area for which a government entity has declared a disaster or relies on help making healthcare decisions from an individual who resides in an affected area.
  2. Is eligible for another election period within the disaster/emergency SEP eligibility period, AND
  1. Has missed that election period because of the effects of the disaster/emergency.

What is the timeframe for this SEP?

The SEP starts as of the date the declaration is made, the incident start date or, if different, the start date identified in the declaration, whichever is earlier. It ends two full calendar months following the end date identified in the declaration or, if different, the date the end of the incident is announced, whichever is later.

Does CMS monitor the use of this SEP?

The Centers for Medicare and Medicaid Services (CMS) monitors the submission of elections utilizing the Disaster/Emergency SEP for irregularities and may reach out to Blue KC for further information about elections submitted using this SEP. As an agent, you will need to provide information confirming all three requirements apply.

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