Special Enrollment

Most employers have an annual open enrollment period when employees can sign up for health care coverage or change to a different health plan. Outside of that period, in order to sign up or change plans employees must have a qualifying event that triggers a special enrollment period. For information on qualifying events, review the following information.

Special Enrollment Quick Reference Chart

Life-Changing Qualifying Event (QE) – Mini-Open Enrollment

Any of the following events would allow the subscriber to change plans and/or add him or herself, or his/her dependents, with the effective dates as listed.

Qualifying event	Effective date determination	Documentation
Newborn	Date of event	Birth certificate.
Adoption or placement for adoption (must be routed to case coordinator)	Date of event	Court documentation showing date when court order effective.
Assumption of a parent-child relationship (must be routed to case coordinator)	Date of event	Court documentation showing date when court order effective.
Marriage	First of the month following date application is received.	Marriage certificate
Domestic partnership	First of the month following date application is received.	Declaration of domestic partnership. Certificate of registered domestic partnership.

Loss of minimum essential coverage

Includes (but is not limited to) any of the following events, which resulted in a loss of minimum essential coverage, NOT INCLUDING voluntary termination, failure to pay premiums or situations allowing rescission for fraud or intentional misrepresentation of material fact.

Qualifying event	Effective date determination	Documentation
Loss of coverage due to death of the covered employee.	Up to sixty (60) days AFTER date of qualifying event: First of the month following date application is received.	One of the following: Prior coverage certificate. Front and back of previous carrier's ID card
Loss of coverage due to termination or reduction of hours, of the covered employee's employment.	Up to sixty (60) days AFTER date of qualifying event: First of the month following date application is received.	One of the following: Prior coverage certificate Front and back of previous carrier's ID card Confirmation of work-hour reduction including termination from employer (must be on employer letterhead and signed by employer management)
Loss of coverage due to divorce or legal separation of the covered employee from the employee's spouse.	Up to sixty (60) days AFTER date of qualifying event: First of the month following date application is received.	One of the following: Prior coverage certificate. Front and back of previous carrier's ID card
The enrollee loses a dependent or is no longer considered a dependent through divorce, legal separation or dissolution of domestic partnership as defined by state law in the state in which the divorce, legal separation or dissolution of domestic partnership occurs or if the enrollee or enrollee's dependent dies.	Up to sixty (60) days AFTER date of qualifying event: First of the month following date application is received.	One of the following: Front and back of previous carrier's ID card Max age letter from previous carrier.
The covered employee becoming entitled to benefits under Medicare.	Up to sixty (60) days AFTER date of qualifying event: First of the month following date application is received.	One of the following: Prior coverage certificate. Front and back of previous carrier's ID card Eligibility document
A dependent child ceasing to be a dependent child under the generally applicable requirements of the plan.	Up to sixty (60) days AFTER date of qualifying event: First of the month following date application is received.	One of the following: Prior coverage certificate. Front and back of previous carrier's ID card Max age letter from previous carrier.
Loss of minimum essential coverage for any reason other than failure to pay premiums or situations allowing for a rescission for fraud or intentional misrepresentation of material fact.	Up to sixty (60) days AFTER date of qualifying event: First of the month following date application is received.	Letter from applicant supporting qualifying event. Letter from previous carrier documenting loss of coverage.
Termination of employer contributions.	Up to sixty (60) days AFTER date of qualifying event: First of the month following date application is received.	Notice from employer of contributions termination.
Exhaustion of COBRA continuation coverage.	Up to sixty (60) days AFTER date of qualifying event: First of the month following date application is received.	COBRA paperwork reflecting exhaustion of coverage.
Loss of medically needy coverage under Medi-Cal (Medicaid).	Up to sixty (60) days AFTER date of qualifying event: First of the month following date application is received.	Medicaid and/or Medi-Cal documentation.
Loss of pregnancy-related coverage under Medicaid and/or Medi-Cal.	Up to sixty (60) days AFTER date of qualifying event: First of the month following date application is received.	Medicaid and/or Medi-Cal documentation.
Losing eligibility for coverage under a Medicaid plan under XIX of the Social Security Act or a state child health plan under XXI of the Social Security Act.	Up to sixty (60) days AFTER date of qualifying event: First of the month following date application is received.	Medicaid documentation.
Becoming eligible for assistance under a Medicaid plan or a state child health plan.	Up to sixty (60) days AFTER date of qualifying event: First of the month following date application is received.	Medicaid documentation.

Other Qualifying Events

Qualifying event	Effective date determination	Documentation
The enrollee or enrollee's dependent's enrollment or non-enrollment in a health plan is unintentional, inadvertent, or erroneous and is the result of the error, misrepresentation, misconduct, or inaction of an officer, employee, a non-Exchange entity providing enrollment assistance or conducting enrollment activities, or agent of the Exchange or the Department of Health and Human Services, or its instrumentalities as evaluated and determined by the Exchange.¹	Management review and approval.	Front and back of previous carrier ID card. Letter from Exchange or HHS documenting qualifying event.
The health plan in which the enrollee or enrollee's dependent is enrolled in substantially violated a material provision of its contract.¹	Management review and approval.	Resolution document from the Exchange or other plan.
The enrollee demonstrates to the Exchange that he or she did not enroll in a health benefit plan during the immediately preceding enrollment period available to the individual because he or she was misinformed that he or she was covered under minimum essential coverage.	Up to sixty (60) days AFTER date of qualifying event: First of the month following date application is received.	Letter from applicant supporting qualifying event. Copy of the plan renewal letter.
The enrollee is a member of the reserve forces of the United States military returning from active duty or a member of the California National Guard returning from active duty service under Title 32 of the United States Code.	Up to sixty (60) days AFTER date of qualifying event: First of the month following date application is received.	Active duty discharge documentation
Release from incarceration	Up to sixty (60) days AFTER date of qualifying event: First of the month following date application is received.	Probation or parole release paperwork showing date of event.
The enrollee is a victim of domestic abuse or spousal abandonment, including a dependent or unmarried victim within a household, and is enrolled in minimum essential coverage and seeks to enroll in coverage separate from the perpetrator of the abuse or abandonment; or is a dependent of a victim of domestic abuse or spousal abandonment, on the same application as the victim.	Up to sixty (60) days AFTER date of qualifying event: First of the month following date application is received.	A signed written statement under penalty of perjury stating enrollee's name and names of the victims of domestic abuse who enrolled in coverage.
The enrollee or enrollee's dependent applies for coverage through Covered California™ during the annual open enrollment period or due to a qualifying event, is assessed by Covered California as potentially eligible for Medi-Cal, and is determined ineligible for Medi-Cal either after open enrollment has ended or more than 60 days after the qualifying event; or applies for coverage with Medi-Cal during the annual open enrollment period and is determined ineligible after open enrollment has ended.	Up to sixty (60) days AFTER date of qualifying event: First of the month following date application is received.	Denial of eligibility letter from Covered California or Medi-Cal.
The enrollee adequately demonstrates to Covered California that a material error related to plan benefits, service area or premium influenced his or her decision to purchase coverage through Covered California.	Up to sixty (60) days AFTER date of qualifying event: First of the month following date application is received.	A signed written statement under penalty of perjury stating enrollee's name, name of the health plan, what error occurred, and the date on which the error occurred.
The enrollee was receiving services under another health benefit plan, from a contracting provider who is no longer participating in that health plan, for any of the following conditions: (a) an acute or serious chronic condition, (b) a terminal illness, (c) a pregnancy, (d) care of a newborn between birth and 36 months, or (e) a surgery or other procedure that has been recommended and documented by the provider to occur within 180 days of the contract's termination date or within 180 days of the effective date of coverage for a newly covered member, and that provider is no longer participating in the health plan.	Up to sixty (60) days AFTER date of qualifying event: First of the month following date application is received.	Letter from health plan that documents the provider's termination from the network. AND Letter from provider that documents the condition of the enrollee.
If the enrollee or enrollee's dependent is Native American and enrolling in a qualified health plan or changing from one qualified health plan to another, one time per month.¹	Up to sixty (60) days AFTER date of qualifying event: First of the month following date application is received.	Prior coverage certificate. A letter or document on tribal letterhead showing enrollee's name and status as a federally-recognized AI/AN; or A signed written statement under penalty of perjury stating enrollee's name and the tribe in which he or she belongs to.
The enrollee or enrollee's dependent gains access to a new health plan as a result of a permanent move.	Up to sixty (60) days AFTER date of qualifying event: First of the month following date application is received.	Copy of acceptable proof of residency documents: Current driver's license or identification card. Current and valid state vehicle registration form in the applicant's name. Evidence the applicant is employed. Evidence the applicant has registered with a public or private employment agency. Evidence that the applicant has enrolled his or her children in a school. Evidence that the applicant is receiving public assistance. Voter registration form of receipt, voter notification card or an abstract of voter registration. Current utility bill in the applicant's name. Current rent or mortgage payment receipt in the applicant's name. Rent receipts provided by a relative shall not be accepted. Mortgage deed showing primary residency. Lease agreement in the applicant's name. Government mail in the applicant's name (SSA statement, DMV notice, etc.). Cell phone bill. Credit card statement. Bank statement or canceled check with printed name and address. U.S. Postal Service change of address confirmation letter. Moving company contract or receipt showing enrollee's address. If enrollee is living in the home of another person, like a family member, friend, or roommate, enrollee may send a letter/statement from that person stating that he or she lives with them and isn't just temporarily visiting. This person must prove his or her own residency by including one of the documents listed above. If enrollee is homeless or in transitional housing, he or she may submit a letter or statement from another resident of the same state, stating that he or she knows where enrollee lives and can verify that he or she lives in the area and isn't just temporarily visiting. This person must prove their own residency by including one of the documents listed above. Letter from a local non-profit social services provider (excluding nonprofit health care providers) or government entity (including a shelter) that can verify that enrollee lives in the area and isn't just visiting.

Type of event	SEP submission time frame
All SEPs except loss of coverage	60 days after event
Loss of coverage only	60 days before date of event 60 days after date of event

¹ These QEs require Health Net management review and approval.