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Qualifying for Special Enrollment

March 13, 2024

Open enrollment is over, but you may still have clients hoping to enroll in or change health plans. What are their options? Read on for a full rundown of special enrollment.

What is special enrollment?

A special enrollment period is a time outside the open enrollment period when your clients can sign up for coverage or shop for a new plan. To qualify for special enrollment, they must’ve experienced a qualifying life event.

What are qualifying life events?

Adding a dependent

  • Marriage or domestic partnership
  • Birth, adoption, or placement for adoption
  • Foster care or binding court order
  • Legal ward or guardianship

Losing a dependent

  • Loss of coverage as a dependent because of death or divorce or termination of a domestic partnership
  • Reaching age 26

Loss of minimum essential coverage

  • Loss of COBRA coverage
  • Loss of employer-sponsored coverage
  • Loss of coverage due to a permanent move
  • Loss of coverage on Medicaid or another public program

Other events

  • Being enrolled in a non-calendar-year plan that is ending outside of open enrollment
  • Change in eligibility for tax credits or cost share reductions
  • System or human errors by your state or federal health plan
  • Late eligibility

How long do my clients have to apply?

In most cases, your clients have 60 days from the qualifying life event date to apply for a health plan and provide the required documentation. Additionally, most qualifying events require proof of minimum essential coverage for at least 1 day of the last 60 days to qualify.

What documentation is required?

Your clients need to provide documentation of their qualifying life event. Depending on the event, required documentation may include:

  • Copy of marriage certificate or declaration of domestic partnership
  • Copy of birth certificate, adoption or foster care papers, or guardianship appointment
  • Copy of death certificate
  • Copy of divorce decree or annulment papers, or affidavit of termination of domestic partnership
  • Letter from the prior health plan company, employer, or COBRA showing proof that coverage was lost and the reason for termination
  • Copy of utility bill at a new permanent address/rental or lease agreement showing prior address and new address

How can my clients learn more and apply?

If you think your client may be eligible, visit our Special Enrollment page for more details.