Special Enrollment Qualifying Events

  • Have you had a baby, gotten married, or had another major life event recently?

    The regular open enrollment period to buy a 2016 individual health plan ended January 31. But, if something has changed and you or your family has experienced a qualifying life event, you may be able to apply for coverage now, in a special enrollment period.

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

    As part of the application process, you'll be asked to provide proof that you're a Washington state resident. Your completed application and supporting documentation must be received within 60 days of the life event. In addition to the requirements listed, you may be asked to provide additional documentation of your life event.

  • Qualifying events:

    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:

    A letter from your employer or COBRA administrator indicating that the loss of COBRA coverage was because you exhausted the COBRA period or exceeded the lifetime limit in the plan. The letter must also state 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 employer or COBRA administrator indicating loss of COBRA coverage 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:

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

    Qualifying event:

    If 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:

    A Letter from the Exchange or health plan indicating that coverage was discontinued by the Exchange, and that the 3-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:

    A 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:

    A copy of divorce decree or annulment papers AND a letter from the prior health plan, or 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:

    A 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:

    A 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:

    A 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.