CurrentAmeriHealthPolicy N/A

Acceptable documents for Off-Exchange Special Enrollment Periods (SEPs)

Lists acceptable supporting documents and enrollment timing rules for individuals applying for an Off-Exchange Special Enrollment Period with AmeriHealth; applies to applicants seeking SEP eligibility and AmeriHealth enrollment staff processing SEP documentation.

Policy Summary

PayerAmeriHealth

PolicyAcceptable documents for Off-Exchange Special Enrollment Periods (SEPs)

Policy CodePolicy N/A

Change TypeNo material changes

Effective DateN/A

Next Review DateN/A

Key ActionSend all documentation to sepdocuments@amerihealth.com and include applicant's name in the email subject.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

60 daysenrollment window after qualifying event

7document categories listed

4supporting item pairs required when moving

Key Definitions

Special Enrollment Period (SEP)

Definition

Policy Summary

PayerAmeriHealth

PolicyAcceptable documents for Off-Exchange Special Enrollment Periods (SEPs)

Policy CodePolicy N/A

Change TypeNo material changes

Effective DateN/A

Next Review DateN/A

Key ActionSend all documentation to sepdocuments@amerihealth.com and include applicant's name in the email subject.

SourceLink

On This Page

Qualifying Life Events and Acceptable Documentation

Loss of Coverage

Acceptable documents to demonstrate loss of prior coverage:

ALL of the following

ONE of
- Termination letter showing date for loss of Medicaid or Medicare coverage
- Letter from your employer confirming loss of coverage and reason
- HIPAA Certificate of Creditable Coverage
- Pay stubs showing reduction in hours with employer documentation that states coverage is not available for employees working the lesser number of hours
- Proof of loss of dependent status due to reaching age 26
- Death certificate of policyholder and prior insurance plan ID card showing dependents
- Official renewal letter issued by your prior insurer showing the plan or policy year period and date of termination (group plans only)
- Letter or other statement from employer showing that coverage doesn't meet minimum value and date it stopped meeting minimum value
- Divorce decree

Birth

Acceptable documents to demonstrate birth:

ONE of

Birth certificate
Dated discharge paperwork for newborn

Adoption

Acceptable documents to demonstrate adoption:

ONE of

Birth certificate
Adoption papers
Court order

Court Order

Acceptable documents to demonstrate court order:

ONE of

Birth certificate
Adoption papers
Court order

Marriage

Acceptable documents to demonstrate marriage:

ALL of the following

ONE of
- Marriage certificate and proof of continuous qualified health coverage
- For children gained through marriage: marriage certificate plus birth certificates for child dependents

Permanent Move

Acceptable documents to demonstrate permanent move (requires proof of prior coverage plus at least four supporting item pairs):

ALL of the following

Proof of prior coverage
AND at least four (4) of the following paired items
- Last utility bill for former residence PLUS initial utility bill for new residence
- Lease or rental agreement for new residence PLUS lease or rental agreement for former residence
- Deed, mortgage or monthly mortgage statement for new residence PLUS deed, mortgage, monthly mortgage statement for former residence

Gained access to an individual coverage HRA

Acceptable documents to demonstrate gaining access to an individual coverage HRA:

ALL of the following

ONE of
- Notice from employer showing individual coverage Health Reimbursement Arrangement (HRA) or QSEHRA dates

OpenPayer

Acceptable documents for Off-Exchange Special Enrollment Periods (SEPs)

Key Definitions

Qualifying Life Events and Acceptable Documentation

Document Submission and Processing Instructions