Helping Clients Navigate Special Enrollment Periods with Confidence

Understanding Special Enrollment Periods (SEPs) allows you to deliver the clear, timely guidance your clients rely on when their coverage needs change. Here’s a quick reminder of SEP best practices to support them during these transitions.

Recognizing Qualifying Events

SEPs are triggered by events such as moving to a new service area, losing employer or other coverage, or changes in Medicaid eligibility. These windows give clients an opportunity to make a change to their coverage outside the Annual Enrollment Period.

Understanding Timelines

SEPs are time-sensitive, and timelines can vary by situation. In many cases, clients have a limited window — typically around 60 days — to make a change following a qualifying event, such as a move or loss of coverage. Changes in Medicaid eligibility may offer more flexibility.

To help your clients take action before the window closes, you might say, “This gives you a limited time to make a change, so let’s take a look at your options.”

Helping Clients Prepare Documentation

Most SEP requests require documentation to confirm eligibility, such as proof of a move, loss of coverage, or Medicaid status.

Let your clients know what documentation may be needed and encourage them to gather it early to keep the process moving smoothly.

Staying Within Compliance

When discussing SEPs, avoid steering clients toward a specific decision to stay compliant with CMS guidelines. This reinforces the trusted relationships you've built with them.

Supporting Clients When It Matters Most

Life changes can be stressful, but they also create opportunities to step in and offer helpful guidance. By understanding SEPs and explaining them clearly, you can help clients choose coverage that better fits their needs and feel confident throughout the process.

If you need help or have questions, contact your local BAE anytime:

Joseph Forcina 
614-260-0661
joseph.forcina@trinity-health.org

Thomas Garrick 
614-562-8025
thomas.garrick@trinity-health.org