Special Enrollment Period (SEP) Law and Legal Definition

Special enrollment period (SEP) refers to a period during which individuals who failed to take medicare part B coverage for themselves and their dependents during the initial enrollment period are allowed to enroll without waiting until the plan's next open enrollment period. For example, if a couple who were working and had group health plan coverage under an employer or union fail to enroll during the initial enrollment period, they can sign up anytime when they are covered under the group plan based on current employment status. The last eight months of the special enrollment period starts the month after the employment ends or the group health coverage ends, whichever comes first.

In Social Security Act special enrollment period (SEP) refers to the period for enrollment in strategic marketplace initiative (SMI) and/or premium hospital insurance (HI) that is provided for individuals who are eligible for SMI, premium HI on the basis of age or as disabled beneficiaries, and have been covered by a group health plan (GHP) or a large group health plan (LGHP) based on current employment status.

A special enrollment period can be triggered to enroll in your company's health plan right away, if you are covered by your spouses plan and loses that coverage because of the spouse loosing the job or divorce. Dependents can be enrolled right away in a special enrollment period, when you marry, have a child, or adopt a child. When no such circumstance occur for triggering the special enrollment period, then such persons will have to wait until the next open enrollment period to sign up for health benefits.

SEP is not offered to individuals with end-stage renal disease (ESRD).