How to Prove You Qualify for a Special Enrollment Period (SEP)
A Special Enrollment Period (SEP) allows you to enroll in a health insurance plan under the Affordable Care Act (ACA) outside of the annual Open Enrollment Period. However, qualifying for a SEP is only part of the process—you must also prove your eligibility to the Marketplace.
Many SEP denials happen not because someone is ineligible, but because the required documentation was incomplete, incorrect, or submitted improperly.
In this guide, we explain how to prove you qualify for a SEP, what documents are accepted, how to submit them correctly, and how to avoid common mistakes that could delay or cancel your coverage.
What Does It Mean to Prove SEP Eligibility?
Proving SEP eligibility means providing official documentation that confirms you experienced a qualifying life event recognized by the ACA and that you meet all related requirements.
The Marketplace reviews:
The type of qualifying event
The exact event date
Supporting documentation
Any additional eligibility rules (such as prior coverage)
If any of these elements are missing or inconsistent, your SEP may be denied or revoked.
Common Qualifying Life Events for SEP
Before gathering documents, confirm that your situation qualifies.
Most common qualifying events
Loss of health coverage
Moving to a new state or county
Marriage
Divorce or legal separation
Birth or adoption of a child
Household changes
Gaining eligible immigration status
Release from incarceration
Certain unexpected or exceptional circumstances
Each event has specific documentation requirements.
General Documents the Marketplace May Request
While requirements vary, commonly accepted documents include:
Official letters or notices
Coverage termination letters
Legal documents
Government-issued records
Proof of address
Proof of prior coverage
All documents must be:
Clear and readable
Official
Dated
Consistent with the information reported on your application
How to Prove SEP Due to Loss of Coverage
Accepted documents
Employer termination letter
Insurance cancellation notice
COBRA notice
Medicaid or CHIP eligibility notice
Final insurance statement
Common mistakes
Submitting documents without dates
Confusing notice date with coverage end date
Not proving the coverage was minimum essential coverage
How to Prove SEP Due to a Move
Moving-related SEPs are among the strictest.
Key requirements
Move to an area with new health plan options
Must have had minimum essential coverage for at least one day in the 60 days before the move (in most cases)
Accepted documents
Lease agreement or mortgage
Utility bills
USPS change-of-address confirmation
Employer letter (if relocation was job-related)
How to Prove SEP Due to Marriage
Accepted documents
Marriage certificate
Official government-issued marriage record
Additional requirement
At least one spouse must usually have had prior qualifying coverage
How to Prove SEP Due to Birth or Adoption
This is one of the most flexible SEP types.
Accepted documents
Birth certificate
Hospital birth record
Adoption papers
Court order
Important benefit
Coverage can often be retroactive to the date of birth or adoption.
How to Upload Documents Correctly
How you submit documents is just as important as the documents themselves.
Best practices
Use clear PDF or JPG files
Avoid blurry photos
Upload documents separately when possible
Use descriptive file names
Ensure all information is visible
Dates: The Most Common Reason for SEP Denials
The Marketplace strictly enforces date rules.
Double-check
Actual event date
Date you reported
Date shown on documents
Your 60-day SEP window
Any mismatch can trigger an automatic denial.
What Happens After You Submit Documents
After submission:
The Marketplace reviews your documents
Your SEP may be approved
Additional documentation may be requested
Your SEP may be denied
Review timelines vary and can take days or weeks.
What to Do If the Marketplace Requests More Information
This does not automatically mean denial.
Recommendations
Respond promptly
Submit only requested documents
Review names and dates carefully
Keep copies of everything
Mistakes You Should Avoid
Uploading incorrect documents
Missing required information
Ignoring deadlines
Assuming approval without confirmation
Overlooking Marketplace notifications
When to Seek Professional Help
Consider professional assistance if:
Your SEP was denied
The Marketplace requests clarification
Your situation is complex
You are unsure about prior coverage rules
You want to avoid losing health coverage
An experienced advisor can help you avoid costly errors.
