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SPECIAL ENROLLMENT
QUALIFYING LIFE EVENTS
LOSS OF COVERAGE
• You Lose Medi-Cal Coverage
• Loss of Employer-Sponsored Coverage
• Your COBRA Coverage is Exhausted.
Note: Not paying your COBRA premium is not considered loss of coverage.
• You Are No Longer Eligible For Student Health Coverage
AGED OUT OF COVERAGE
• You Turn 26 Years Old and Are No Longer Eligible For A Parent's Plan
• You Turn 19 Years Old and Are No Longer Eligible For A Child-Only Plan
RECENTLY MOVED
• You Move To California From Out of State
• You Move Within California and Gain Access To At Least One New Covered California Health Insurance Plan.
NEW BABY ARRIVAL
• A Child is Born, Adopted or Received Into Foster Care. The Entire Family Can Use The Special Enrollment Period To Enroll In Coverage.
• If You Place Your Child For Adoption or Foster Care, You Can Use The Special Enrollment Period To Enroll In Coverage.
MARRIAGE/DIVORCE
• One or Both Members of The New Couple Can Use The Special Enrollment Period To Enroll In Coverage.
NEW SUBSIDY ELIGIBILITY
• You Are Already Enrolled In A Covered California Plan And Become Newly Eligible or Ineligible For Tax Credits or Cost-Sharing Reductions.
MAJOR CHANGES
• You Become A Citizen, National, or Permanent Legal Resident.
• You Have Been Released From Jail or Prison.
• You Have Lost Coverage After Leaving Active Duty, Reserve Duty, or The California National Guard.
OTHER QUALIFYING EVENTS
• If You Are A Member of A Federally Recognized American Indian Tribe, You Can Enroll At Any Time And Change Plans Once Per Month.
•Misconduct or Misinformation Occured During Your Enrollment.
Such As: An Agent, Certified Enroller, Service Center Representative or Other Authorized Representative Enrolled You Into A Plan You Did Not Want To Enroll In, Failed To Enroll You Into Any Plan or Failed To Calculate Premium Assistance For Which You Were Eligible.
• You Are Already Enrolled In A Covered California Plan And You Lose A Dependent Due To Divorce, Legal Seperation, Dissolution of Domestic Partnership, or Death.
• Misrepresentation or Erroneous Enrollment.
Such As: Incorrect Eligibility Determination, The Health Plan Did Not Receive Your Information Due To Technical Issues, Incorrect Plan Data Was Displayed When You Selected A Plan, Your Helath Plan Violated It's Contract.
•Exceptions Circumstance Occurred On or Around Plan Selection Deadlines, Including Natural Disasters and Medical Emergencies.
•If You and Your Dependents, If Any, Are Victims of Domestic Abuse or Spousal Abandonment.
• If You Have Ended Your Service or Have Become A Member Outside of Open Enrollment for AmeriCorps/VISTA/National Civilian Community Corps.
• Your Provider Left The Health Plan Network While You Were Receiving Care For Certain Conditions. Such As: Pregnancy, Terminal Illness, An Acute Condition, A Serious Chronic Condition, The Care of A Newborn Child Between Birth Ang Age of 36 Months, A Surgery or Other Procedure That Will Occur Within 180 Days of The Termination or Start Date.
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