Open Enrollment ends Dec 15 — only 19 days left!

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See if you qualify for a Special Enrollment Period (SEP)

Did you or anyone in your household lose qualifying health coverage in the past 60 days OR do you expect anyone in your household to lose coverage in the next 60 days?

YES NO

Did any of the following apply to you or anyone in your household in the past 60 days?

Changes in household size:

YES NO Got married
YES NO Had a baby
YES NO Gained/became a dependent
YES NO Got divorced or legally separated and lost health insurance
YES NO Death

Changes in residence or income:

YES NO Changed your primary place of living
YES NO Had a change in income

Changes in status:

YES NO Denied Medicaid/CHIP
YES NO Gained citizenship or lawful presence in the U.S.
YES NO Was released from incarceration (detention, jail, or prison)

Did your employer offer to help with the cost of coverage either through an individual coverage HRA or a QSEHRA?

YES NO

Are you a member of a federally recognized tribe, or an Alaska Native corporation shareholder?

YES NO
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