Highmark: Your Quick Guide to SEP Enrollments

Special Enrollment Period (SEP) Refresher

While the ACA Open Enrollment Period is over, the need for health insurance continues. The focus is now on assisting individuals in obtaining coverage through Special Enrollment Periods (SEPs), available year-round for qualifying life events.

Qualifying Life Event Examples Include:

• Loss of existing health coverage, including job-based, individual, and student plans
• Loss of eligibility for Medicare, Medicaid, or CHIP
• Marriage or divorce
• Birth or adoption of a child
• Change in income
• Change in residence
• Death of a family member

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Deadline:

• While most applications must be submitted within 60 days of coverage ending, some situations allow for submission up to 60 days in advance.
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Effective Date:

• In most cases, this will be the first day of the month immediately following the application, or the second month after the application, depending on the type of special enrollment and date of application.

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Submission Process - Off-Exchange:

• Completed applications, SEP forms, and supporting documentation can be sent to:
  • PA/DE/WV: DP_Applications@highmark.com / Fax: 866-224-5403
  • NY: HNY-State_Specialists@highmark.com or ACAEBNY@highmarkhealth.org
• Note: The Producer Portal is only open to ICHRA and QSEHRA SEP submissions. For more information regarding ICHRA submissions, please contact ICHRA@highmark.com.

Submission Process - On-Exchange:

• Applications will need to be submitted through your state's exchange (Pennie, Marketplace, NY Exchange).

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Highmark Resources:

• Digital applications, SEP forms, and change forms are available for download on the Producer Portal, producer.highmark.com, under Resources.
• Physical copies of applications can be ordered on Marcom, under 2025 ACA Enrollment Materials.

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