Individuals must experience a Qualifying Life Event (QLE) to be eligible to enroll for coverage during a Special Enrollment Period (SEP).

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1 Individuals must experience a Qualifying Life Event (QLE) to be eligible to enroll for coverage during a Special Enrollment Period (SEP). Individuals who experience a QLE and are currently enrolled through the, or wish to enroll as a new applicant, must go directly to the. The Direct Enrollment connection between Humana and the will be turned off and messaging will be posted to the website directing users to the Federal or state. Quoting for On plans will remain available on Agent Work Bench (AWB), however On direct enrollment will be disabled during SEP. All changes that impact eligibility and circumstances must be made directly with the to determine the impact on any financial assistance with Advance Premium Tax Credits and/or cost sharing reductions. If sending a consumer to the, please remember to give them your NPN so they can give the the proper information for an agent assisted sale. The enrollment process for Off plans during SEP will be similar to enrollment during Open Enrollment except a QLE and QLE Date will be required when generating a quote in AWB. Important note about effective dates: Special Enrollment Period (SEP): Except for Qualified Life Events of Annual Renewal OR Loss of Coverage; the Special Enrollment Period begins on the Qualified Life Event date and they have 60 days to complete and submit an application. This means for all other life events; you should not complete and submit an application prior to the Qualified Life Event date. Please note that as a courtesy for our consumers Humana is allowing for Loss of Coverage the ability for consumers to apply 30 days prior to their termination date. Reminder-Effective Date Rules: Adoption or placement for adoption, Birth of Child; coverage is effective on the date of adoption or placement for adoption or birth of the child Loss of minimum essential coverage or Marriage, coverage is effective the first of the following month Gain Citizen status, Gain Resident Status, No longer incarcerated or Relocation; follow Open Enrollment Logic o Application is submitted between first and fifteenth (1 st -15 th ) of the month, coverage must be effective the first of the following month o Application is submitted between sixteenth and last day (16 th -31 st ) of the month, coverage must be must be effective the first of second following month Please note that Humana will assign the effective date of coverage once eligibility determination has been made. GCHJ565EN

2 Some of the QLEs are as follows: as of 1/1/2015 Life Event Birth Date of Birth All family members are eligible for the SEP Pregnancy is NOT a QLE, and will not be eligible until after the birth of the child. However, pregnancy may make an individual eligible for Medicaid, and Medicaid eligibility may be pursued. Adoption Date of Adoption All family members are eligible for the SEP Marriage Loss of employer sponsored health insurance, as a result of Termination of employment Employer reduces work hours to the point where no longer covered by the health plan Employer s plan decides it will no longer offer coverage to a certain group of individuals for example, those who work part time) Termination of employer contributions Loss of coverage for a dependent child who has reached the dependent limiting age All family members are eligible for the SEP An SEP is not available in the following circumstances: Voluntarily quitting other health coverage or being terminated for not paying premiums Losing coverage that is not considered minimum essential coverage (example: Limited Benefit, Short Term Medical Plans) If offered COBRA coverage, individual is not required to take the coverage. If enrolled in COBRA, they must exhaust COBRA (or enter Open Enrollment period) before eligible for a QLE. Voluntarily dropping COBRA after enrollment is not a QLE.

3 Exhaustion of COBRA Loss of eligibility for Medicaid or CHIP Divorce/Legal Separation Loss of retiree coverage due to former employer filing for bankruptcy protection If offered COBRA coverage, individual is not required to take the coverage. However, if enrolled in COBRA, they must exhaust COBRA (or enter Open Enrollment period) before eligible for a QLE. Voluntarily dropping COBRA after enrollment is not a QLE. Individual must actually have been enrolled in Medicaid or CHIP plan, and are losing coverage. A court order to provide health insurance for a child is not, by itself, a QLE. There must be an underlying event like loss of coverage to make the child eligible for an SEP. Death of the policyholder Incur a claim that meets or exceeds a lifetime limit on all benefits under existing coverage Gaining status as a citizen, national or lawfully present individual Follows Open Enrollment

4 No longer incarcerated Follows Open Enrollment Discharge from active military duty 1 st of the following month Loss of coverage due to a permanent move outside of the plan s service area Renewal of a pre-aca individual plan during 2014 and 2015 Follows Open Enrollment 60 days prior to renewal date and 60 days after the renewal date of the policy New address must have a different zip code to be considered eligible. Individual is eligible even if current coverage is not being cancelled due to the move, or if never had coverage. Includes both grandfathered and nongrandfathered plans.

5 Beginning or Concluding Service in the AmeriCorps State and National, VISTA or NCCC programs Follows Open Enrollment Ineligible for Basic Plan NA Follows Open Enrollment Nevada Open Enrollment NA after a 90 day waiting period from date of application Change in income that affects eligibility for tax credits (APTC) or costsharing reductions (CSR) Determined by Individuals who enrolled in a Humana Basic plan Off during Open Enrollment and who then determine they are not eligible for the plan (under 30 or no financial hardship) may apply for a new plan outside of Open Enrollment. Nevada specific Applies only to individuals who are already enrolled in coverage. If individual elected not to enroll in coverage during OEP, a change in income will not result in an SEP. Includes individuals whose existing employersponsored coverage will no longer be affordable or provide minimum value.

6 Exceptional circumstances as defined by the, includes: Enrollment or non-enrollment in a plan is unintentional or erroneous and is the result of an error/misrepresentation or inaction of an agent of the Individual demonstrates to the marketplace that the plan in which they are in rolled substantially violated a material provision of its contract Indians (as defined in the Indian Health Care Improvement Act) may enroll in a plan or change from one plan to another one time per month Determined by NA Determined by Determined by Only the can grant this QLE. For a complete list and more information about QLEs and SEPs for On enrollments, please visit An SEP is not available in the following circumstances: Voluntarily quitting other health coverage or being terminated for not paying premiums, Losing coverage that is not considered minimum essential coverage. In addition to the above items, Life Events specific to individuals already enrolled in coverage: A change in income or household status that affects eligibility for tax credits or cost-sharing reductions Exceptional circumstances as defined by the Nevada Exception The State of Nevada requires carriers to offer open enrollment all year round. February 16, 2015 October 14, 2015, individuals can enroll for coverage without a QLE, and will need to select the option of None in the QLE list when applying for coverage. The effective date will be the 1 st of the following month after a 90 day waiting period. Humana systems will not be updated to handle this effective date logic until later in the year, so all applications will be reviewed by Humana and the effective date manually updated prior to issuance. For more information please visit the NV. Colorado and Kentucky State s

7 Kentucky s Kynect website will include an option for agents and consumers to select Report a Change and will see new screens to select the QLE in order to determine their SEP eligibility. Agents will be able to assist consumers with this process and complete enrollments. For more information please visit Kynect. In Colorado, all SEP transactions will need to go through Colorado s Service Center. Consumers will be able to log in or create an account on the C4HCO website, but the website will direct them to the Service Center in order to complete any transactions. For more information please visit C4HCO. GCHJ565EN