KBenefits Insurance Services
Special Enrollment Periods

Special Enrollment Period for Employer Groups

Special Enrollment Period

November 15 - December 15.  
Under the SEP, small employers are exempt from certain contribution and participation requirements for coverage effective January 1st.

Employers can waive:

  • The minimum participation rate of 75% of FT employees is waived during the S.E.P. period.  Small employers can offer a group health plan to their employees even if the group doesn't meet the minimum 75% participation requirement.
     
  • Employers can waive the employer contribution to reduce employer expenses yet still over a group health plan to the employees.

 

Need assistance?
For questions, quotes and enrollment assistance, call 732-333-1976 or
chris@kbenefits.com.

Under Small Group 
Special Enrollment Period for Employees / Qualifying Events

The Special Enrollment Period begins on the date of the event and lasts for either 30 or 60 days following the event, as stated below.

1) The date an employee or dependent loses eligibility for minimum essential coverage, including a loss of coverage resulting from the decertification of a qualified health plan by the marketplace. A loss of coverage resulting from nonpayment of premium, fraud or misrepresentation of material fact shall not be a Triggering Event. The Special Enrollment Period lasts for 30 days following this event.

2) The date an employee acquires a dependent or becomes a dependent due to marriage, birth, adoption, placement for adoption, or placement in foster care. The Special Enrollment Period lasts for 30 days following this event.

3) The date an employee’s enrollment or non-enrollment in a qualified health plan is the result of error, misrepresentation or inaction by the federal government. The Special Enrollment Period lasts for 30 days following this event.

4) The date an employee or eligible dependent demonstrates to the marketplace that the qualified health plan in which he or she is enrolled substantially violated a material provision of its contract in relation to the enrollee. The Special Enrollment Period lasts for 30 days following this event.

5) The date the employee or dependent gains access to new qualified health plans as a result of a permanent move. The Special Enrollment Period lasts for 30 days following this event.

6) The date the employee or dependent loses or gains eligibility under Medicaid or NJFamilyCare. The Special Enrollment Period lasts for 60 days following this event.

7) The date of a court order that requires coverage of a dependent. The Special Enrollment Period lasts for 60 days following this event.

Christopher S. Kudryk
Insurance Specialist
chris@kbenefits.com
732-333-1976

KBenefits Insurance Services provides insurance solutions for small business owners and individuals in New Jersey, New York, Penn and Florida..

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