Qualifying Life Events
Question: If I do not sign up with Covered California during the open enrollment period, what happens if I want to enroll later?
Answer: There are certain qualifying events that must be met in order to be eligible for special enrollment (outside open enrollment) in Covered California. The length of the special enrollment window is 60 days after the qualifying event. If you do not meet one of these qualifying events, you must wait until the next open enrollment period. Here is a list of qualifying events that will trigger a special enrollment> Special enrollment periods triggered by:
- A qualified individual or a dependent’s loss of Minimum Essential Coverage;
- A qualified individual gains a dependent or becomes a dependent;
- An individual not previously a U.S. citizen, U.S. national or lawfully present gains such
- A qualified individual’s enrollment or disenrollment in a Covered California Plan (CCP) is unintentional, inadvertent, or erroneous as a result of an error, misrepresentation, or inaction of the staff or instrumentalities of Covered California or Health and Human Services. In such cases, Covered California takes necessary actions to correct or eliminate the effects of an identified determination error, misrepresentation or inaction.
- An enrollee adequately demonstrates that a CCP substantially violated a material provision of its contract in relation to the enrollee.
- An enrollee is determined newly eligible or newly ineligible for advanced premium tax credit (APTC) or has a change in eligibility for CSR;
- An individual whose existing coverage through an eligible employer-sponsored plan will no longer be affordable or provide minimum value.
- A qualified individual or enrollee gains access to new CCPs as a result of a permanent move; also applies to individuals recently released from incarceration.
- A qualified individual who is an Indian may enroll in a CCP or change to another from one time per month.
Initial Open Enrollment Period – October 1, 2013 through March 31, 2014 Subsequent Open Enrollment Period – October 15 through December 7 annually