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, in a special enrollment period.

    If you qualify for a special enrollment period, 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 events:

    The birth, placement for adoption or adoption of the applicant for whom coverage is sought; for Qualified Health Plans (QHPs), 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 individual exhausting the COBRA period or exceeding the lifetime limit in the plan and that no other COBRA coverage is available

    Qualifying event:

    Loss of COBRA coverage due to failure of the employer to remit premium

    Required documentation:

    Letter from the employer or COBRA administrator indicating loss was due to the failure of the employer to remit premium

    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 that the loss of coverage is due to age

    Qualifying event:

    Coverage is discontinued in a qualified health plan by the health benefit exchange and the three-month grace period for continuation of coverage has expired

    Required documentation:

    Letter from the Exchange or health plan indicating that coverage was discontinued by the Exchange and the three- month grace period for continuation of coverage has expired

    Qualifying event:

    If the person discontinues coverage under the Washington State Health Insurance Pool (WSHIP)

    Required documentation:

    Letter from WSHIP indicating coverage has been discontinued

    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 (including the date) the domestic partnership ended, AND a letter from the prior health plan

    Qualifying event:

    Loss of minimum essential benefits, 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 purchased on the Exchange, due to an error by the Exchange, the health plan, or Health and Human Services (HHS)

    Required documentation:

    Letter from the Exchange, health plan, or HHS indicating that coverage was lost due to an error

    Qualifying event:

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

    Required documentation:

    Copy of marriage certificate, state registration, utility bill, a declaration of domestic partnership, lease, or car title with both names clearly listed

    Qualifying event:

    The loss of eligibility for Medicaid or a public program providing health benefits

    Required documentation:

    Letter from Medicaid or other program indicating loss of eligibility

    Qualifying event:

    Loss of minimum essential benefits, including the 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 that experienced a loss of coverage AND reason for termination of health coverage

    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 that the loss of coverage is due to not being in a class of similarly situated individuals

    Qualifying event:

    A permanent change in residence, work, or living situation, where the prior health plan does not provide coverage in that person's new service area

    Required documentation:

    Documentation such as a utility bill, rental, or lease agreement showing the prior address and new address within the last 90 days, and documentation from the prior health plan indicating a loss of coverage