Special Enrollment Qualifying Events

  • The regular open enrollment period for 2015 health coverage ended February 15. But if you or your family has experienced one of the life events listed below, you may be able to apply for coverage now, as a special enrollment.

    If you qualify for a special enrollment, shop for plans now, or call us at 877-PREMERA (877-773-6372) for help in choosing a plan that’s right for you.

    Your completed application and supporting documentation must be received within 60 days of the life event. Review the specific documentation requirements for the event that applies to you:

  • Qualifying event:

    The birth, placement for adoption, or adoption of the applicant for whom coverage is sought; for Qualified Health Plans (QHPs), this also applies to children placed in foster care, legal wards, guardianship, or medical support orders

    Required documentation:

    • Copy of birth certificate
    • Copy of the adoption papers
    • Copy of foster care papers
    • Copy of medical support order
    • Copy of the court order appointing a guardian

    Qualifying event:

    The COBRA coverage period ends (usually after 18 months) or the individual has exceeded the lifetime limit in the plan and no other COBRA coverage is available

    Note: Voluntary termination of COBRA is not a qualifying event. If you terminate or stop paying for your COBRA, you must wait for the next Open Enrollment Period to apply.

    Required documentation:

    Letter from the employer or COBRA administrator indicating that the loss of COBRA coverage is due to the individual's exhausting the COBRA period or exceeding the lifetime limit in the plan and that no other COBRA coverage is available

    Qualifying event:

    Marriage or entering into a domestic partnership, including eligibility as a dependent

    Required documentation:

    Copy of marriage certificate, or a Declaration of Domestic Partnership (a Declaration of Domestic Partnership form can be found on our website at premera.com)

    Qualifying event:

    The loss of coverage as the result of dissolution of marriage or termination of a domestic partnership

    Required documentation:

    Copy of divorce decree or annulment papers, a statement that includes the date that the Domestic Partnership ended, AND a letter from the prior health plan

    Qualifying event:

    Loss of minimum essential coverage, including loss of employer-sponsored insurance coverage (except for voluntary termination of health coverage, misrepresentation, or fraud)

    Required documentation:

    Your COBRA offer letter or a letter from your employer listing each applicant who experienced a loss of coverage AND the reason for termination of health coverage

    Qualifying event:

    Loss of coverage as the result of the death of an employee

    Required documentation:

    The COBRA offer letter or a letter from the employer indicating that the loss of coverage is due to the employee's death

    Qualifying event:

    Termination of employer contributions for coverage other than COBRA

    Required documentation:

    Letter from employer indicating that the loss of coverage is due to termination of employer contributions

    Qualifying event:

    Loss of coverage as the result of a termination in employment or reduction in hours

    Required documentation:

    Your COBRA offer letter or letter from your employer indicating that the loss of coverage is due to a termination in employment or a reduction in hours

    Qualifying event:

    A loss of Medicaid or other public program providing health benefits

    Required documentation:

    Letter from Medicaid or other program indicating ineligibility or loss of coverage

    Qualifying event:

    A qualified individual or enrollee gains access to new Qualified Health Plans (QHPs) as a result of a permanent move

    Required documentation:

    Utility bills from your prior address and new address from within the last 90 days

    Qualifying event:

    A situation in which a plan no longer offers benefits to the class of similarly situated individuals that includes the applicant

    Required documentation:

    Letter from the prior health plan indicating loss of coverage is due to not being in a class of similarly situated individuals

    Qualifying event:

    Loss of coverage as a dependent on a group plan due to age

    Required documentation:

    Letter from employer or insurance health plan indicating the loss of coverage is due to age

    Qualifying event:

    Loss of minimum essential coverage, including loss of employer sponsored insurance coverage; except for voluntary termination of health coverage, misrepresentation, or fraud

    Required documentation:

    Your COBRA offer letter or a letter from your employer listing each applicant who experienced a loss of coverage AND reason for termination of health coverage