Understanding Special Enrollment Periods for Health Insurance Plans During Natural Disasters

From hurricanes to wildfires to flooding and more, a lot has been happening in the world regarding natural disasters. In fact, research in 2023 found that the number of disaster events has increased from 100 per year in the 1970s to around 400 events per year worldwide in the past 20 years.

Knowing how natural disasters affect health insurance and understanding the enrollment periods created specifically for them is essential. All agents should know the basics about special enrollment periods due to natural disasters regardless of their line of business, personal location, or licensed state. This year alone has proven that any state could experience a natural disaster at any point.

This blog will give a quick overview of special enrollment periods and qualifying life events. Then, we’ll discuss how natural disasters factor into the conversation. Additionally, we’ll touch on how individual health, group benefits, and senior insurance agents can use technology to efficiently manage clients during and after a natural disaster. 

For additional information, visit HealthCare.gov’s Special Enrollment Periods for Complex Issues page.

What is a Special Enrollment Period & How Does Someone Qualify?

A special enrollment period (SEP) is a time outside of the yearly enrollment season when consumers can sign up for or make changes to their health insurance coverage. In most cases, a consumer can qualify for an SEP for one of the following reasons:

• They have a qualifying life event (QLE) 
• Their estimated household income is within a certain range
• They have a special situation

Let’s dive further into QLEs and special situations. 

What is a Qualified Life Event?

A qualified life event (QLE) is a significant change in a consumer’s life that qualifies them for a special enrollment period outside of yearly enrollment. Often, a list of possible QLEs includes:

• Having a baby
• Getting married
• Moving
• Losing a job that was the primary health coverage provider
• Losing Medicaid coverage
• Losing Children’s Health Insurance Program (CHIP) coverage

QLEs are very common in the industry and are not always directly related to natural disasters. However, they can be connected to the effects of a disaster.

What is a Natural Disaster Special Enrollment Period?

A natural disaster is considered part of the “special or unexpected” types of situations. A natural disaster can be an earthquake, massive flooding, hurricane, or something else. However, to qualify for a SEP from a natural disaster, there are rules. HealthCare.Gov covers this:

• “To qualify due to a natural disaster, you must live (or have lived during the event) in a county that is eligible to apply for ‘individual assistance’ or ‘public assistance’ by the Federal Emergency Management Agency (FEMA).
• You have 60 days from the end of the FEMA-designated incident period to complete your enrollment in Marketplace coverage.
• You can also ask to have your plan start date be when you would have picked a plan if not for the disaster.”

For more information about FEMA, here are some resources:

• To understand how disasters are declared, visit this page.
• To search for areas declared a natural disaster by FEMA, visit this search tool.

When Does a Natural Disaster Special Enrollment Period Start & End?

Ritter Insurance Marketing shares that an emergency SEP, which a natural disaster SEP would fall under, can start based on the following:

• The date the declaration is made
• The incident start date
• The start date identified by the declaration 

Usually, an emergency SEP would last 60 days, or two months, after the declared end. However, different factors can affect the length, like if the end date is not identified. Ritter shares that the “maximum length of an emergency SEP, if the incident end date is not otherwise identified, is 14 full calendar months after the SEP start date (or the date of a renewal or extension of the declaration).”

The Steps Health Insurance Agents Need to Follow for Natural Disaster Enrollments

Again, Ritter Insurance Marketing has advice all health insurance agents can follow:

• Ask the consumer if they can show proof that they lived/live in an impacted area at the start of the SEP eligibility period.
• If they do not have proof, ask them to verbally attest. It is best practice to use an AMS with built-in VoIP or call recording capabilities to document the verbal attestation. 
• Confirm they had another valid election period available during the time of the incident period and did not make an election during that valid election period due to the disaster/emergency.
• Confirm that the consumer lived in a county that has been declared an emergency or major disaster. 
• During the application process, ensure these two reasons are selected: affected by an emergency or major disaster AND election period enrollee was eligible for and not able to use due to the declared disaster or emergency. 

For questions, contact the Marketplace Call Center, contact CMS, or connect with your upline for additional information.

How to Efficiently Manage Special Enrollment Periods & Qualifying Life Events

During a disaster, your clients want someone to understand and provide assistance. As an insurance agent, you can do just that. 

Approach these conversations with sympathy and be the resource they need. For many, health insurance might be the last thing on their mind — even during peak enrollment periods. However, you know it’s a very critical piece of the puzzle. And knowing who is affected is half the battle.

When you use an agency management system or insurance CRM that houses all your client data in one place, finding this information is simple. In AgencyBloc’s AMS+ solution, run a quick report that identifies all your current policy-holding clients in a specific county to know who could be affected. 

Then, craft messaging to reach out. Send a mass email to that segmented list, send one-off emails, or make personal calls depending on the size of the list. Ensure the message includes information for the next steps, your sympathy for what they’re experiencing, and how you’re there to support them every step of the way. 

When clients know you care about them, it can go a long way toward ensuring their retention for the future — which we all know is the best way to build an insurance business.

Posted by Allison Babberl on Tuesday, October 29, 2024 in Independent Insurance Agents/Agencies

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