Buying SHOP Marketplace Coverage Outside 

of the Enrollment Period 

Qualified employees and their dependents (if you offer dependent coverage), may have a right 

to sign up for your coverage or make changes to their coverage choices outside of your 

enrollment period. Job-based plans must provide this Special Enrollment Period (SEP) of 30 

days following certain life events that involve a change in dependent status or loss of other 

health coverage. If you don’t offer dependent coverage, an SEP applies only to qualified 

employees.

Qualifying life events that create an SEP

To qualify for an SEP, employees and their dependents (if you offer dependent coverage) must 

have a qualifying life event. Qualifying life events that create an SEP include:

• A dependent is added through marriage, birth, adoption, or placement for foster care.

• An employee or dependent loses minimum essential coverage, like when an employee 

loses job-based coverage or the Small Business Health Options Program (SHOP) 

Marketplace no longer certifies the employee’s plan to offer coverage.

• An employee moves to a new state and gains 

access to an employer’s health plan.

• An employee’s enrollment or failure to 

enroll in a plan is the result of the error, 

misrepresentation, or inaction of an officer, 

employee, or agent of the SHOP Marketplace, 

or the U.S. Department of Health and 

Human Services (HHS). The SHOP 

Marketplace will evaluate and decide if 

these instances apply.

• An employee proves to the SHOP 

Marketplace that the plan they’re 

currently enrolled in has violated a 

provision of its contract that relates to 

the employee.
Notifying the SHOP Marketplace of life events

An employee must notify the SHOP Marketplace of a life event that triggers an SEP no later 

than 30 days from the date of the event. Employees that either become eligible for or lose 

eligibility for Medicaid or the Children’s Health Insurance Program (CHIP), have 60 days from 

the date of the event to notify the SHOP Marketplace. If an employee doesn’t notify the SHOP 

Marketplace within the required timeframe, the employee must wait until the next enrollment 

period to make a change.

Important: Employees must report life events to you, and you’re responsible for notifying the 

SHOP Marketplace.

Effective dates of coverage for life events

In most cases, if the SHOP Marketplace is notified by the 15th of the month, the change in 

coverage will become effective the first of the following month. If the SHOP Marketplace is 

notified of the change in coverage after the 15th, the effective date is the first day of the 

second month.

If you offer dependent coverage, some life events allow for the change to become effective on 

the day it occurs, like the birth of a child, adoption, and placement for adoption or foster care. 

You must notify the SHOP Marketplace within 30 days of these events.

In the case of marriage or loss of other coverage, the effective date for the change is always 

the first of the month. The month the change becomes effective depends on when you notify 

the SHOP Marketplace.

For example, if an employee gets married on January 5, 2016, and reports it on:

• January 10, 2016, the coverage start date will be February 1, 2016.

• January 31, 2016, the coverage start date will be February 1, 2016.

• February 1, 2016, the coverage start date will be March 1, 2016.

Employees who miss the enrollment period

If you have an employee that was offered SHOP Marketplace coverage but didn’t enroll, the 

employee will have to wait until you renew coverage to enroll. The employee can’t enroll in 

coverage outside of the enrollment period unless they have a qualifying life event.
Coverage for new employees

When you first enroll in the SHOP Marketplace, you’ll decide how long new employees must 

wait before getting health coverage. The waiting period options are 0, 15, 30, 45, or 60 days. 

Coverage effective dates for new employees are always the first of the month. Once the new 

employee is eligible, the employee will have 30 days to accept your coverage offer and enroll. 

The coverage effective date is based on when the employee enrolls. If the employee enrolls 

on or before the 15th of the month, coverage will be effective on the first of the following 

month. If the employee enrolls after the 15th of the month, coverage will be effective on the 

first of the second month.

For example: John, owner of ABC Garage, chose a 60 day waiting period for new employees. 

Maria was hired by John on May 10. Maria is eligible for coverage as of July 10 (60 days after 

she was hired). She must accept and enroll in coverage within 30 days of becoming eligible 

on July 10.

 • If she enrolls by July 15, the coverage will be effective August 1. 

 • If she enrolls by July 18, the coverage will be effective September 1.

You can make changes to the new employee waiting period only when it’s time to renew your 

coverage. You can’t to make any changes outside of your enrollment period.

CMS Product No. 11779

Revised November 2015