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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.
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•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.
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• 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.
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• 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.
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•Exceptions Circumstance Occurred On or Around Plan Selection Deadlines, Including Natural Disasters and Medical Emergencies.
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•If You and Your Dependents, If Any, Are Victims of Domestic Abuse or Spousal Abandonment.
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• If You Have Ended Your Service or Have Become A Member Outside of Open Enrollment for AmeriCorps/VISTA/National Civilian Community Corps.
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• 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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