Qualifying Life Events

To enroll in coverage outside of Covered California’s Open Enrollment Period, consumers must experience a "qualifying life event." Most special enrollment periods last 60 days from the date of the qualifying life event.


In most cases, consumers must report changes and select a plan within 60 days of the qualifying life event to purchase a Covered California health insurance plan, or change an existing plan, outside of open enrollment. Medi-Cal is available all year, and no qualifying life event or Special Enrollment Period is required to enroll in Medi-Cal.


In most cases, consumers must report changes and select a plan within 60 days of the qualifying life event to purchase a Covered California health insurance plan, or change an existing plan, outside of open enrollment. Medi-Cal is available all year, and no qualifying life event or special enrollment period is required to enroll in Medi-Cal.

Applying Online

When consumers apply for coverage, they will need to select a qualifying life event from a drop-down menu and will be asked the date of the event. The chart below will help you answer those questions. If you have additional questions about whether you qualify for a special enrollment period, call the Covered California Service Center at (800) 300-1506 and speak to a Service Center Representative.

Qualifying Life Events

Lost or will soon lose my health insurance  Examples:

  • You lose Medi-Cal coverage.

  • You lose your employer-sponsored coverage.

  • Your COBRA coverage is exhausted. Note: Not paying your COBRA premium is not considered loss of coverage.You are no longer eligible for student health coverage.

  • You turn 26 years old and are no longer eligible for a parent’s plan.

  • You turn 19 years old and are no longer eligible for a child-only plan.

Permanently moved to/within California Examples:

  • You move to California from out of state. 

  • You move within California and gain access to at least one new Covered California health insurance plan.

Had a baby or adopted a child Examples:

  • A child is born, adopted or received into foster care.

  • The entire family can use the special enrollment period to enroll in coverage. 

Got married or entered into domestic partnership Example:

  • One or both members of the new couple can use the special enrollment period to enroll in coverage.

Returned from active duty military service Example:

  • You have lost coverage after leaving active duty, reserve duty, or the California National Guard.

Released from jail or prison

Gained citizenship/lawful presence Example:

  • You become a citizen, national, or permanent legal resident.

Federally Recognized American Indian/Alaska Native Example:

  • If you are a member of a federally recognized American Indian tribe, you can enroll at any time and change plans once per month.

Other qualifying life event Examples:

  • You are already enrolled in a Covered California plan and become newly eligible or ineligible for tax credits or cost-sharing reductions.  

  • You are already enrolled in a Covered California plan and you lose a dependent or lose your status as a dependent due to divorce, legal separation, dissolution of domestic partnership, or death.

  • Misconduct or misinformation occurred during your enrollment, including:

  • An agent, certified enroller, Service Center representative or other authorized representative enrolled you in a plan that you did not want to enroll in, failed to enroll you in any plan or failed to calculate premium assistance for which you were eligible.  

  • Misrepresentation or erroneous enrollment, including: 

  • Incorrect eligibility determination. This includes if you applied during open enrollment and were initially told you were eligible for Medi-Cal and then later determined not to be eligible for Medi-Cal.

  • The health plan did not receive your information due to technical issues

  • .An error in processing your verification documents resulted in an incorrect eligibility result.

  • Incorrect plan data were displayed when you selected a plan: Data errors on premiums, benefits or copay/deductibles were displayed; incorrect plans were displayed; or a family could not enroll together in a single plan. 

  • Your health plan violated its contract. 

  • Exceptional circumstances occurred on or around plan selection deadlines, including natural disasters and medical emergencies. 

  • You received a certificate of exemption for hardship from Health and Human Services for a month or months during the coverage year but lost eligibility for the hardship exemption outside of an open enrollment period.

  • You and your dependents, if any, are victims of domestic abuse or spousal abandonment

  • You are required by court order to provide health insurance for a child who was been determined ineligible for Medi-Cal and CHIP, even if you are not the party who  expects to claim the child as a tax dependent. 

  • You lose “share of cost” Medi-Cal coverage by reaching your share of cost.

  • You are a member of AmeriCorps/VISTA/National Civilian Community Corps:  

  • If you entered AmeriCorps or one of the other organizations listed above outside of open enrollment.

  • If you ended your service with one of the organizations listed above.

  • You have a non-calendar year health plan (including “grandfathered” and “non-grandfathered” health insurance plan) outside of Covered California that has expired or will soon expire, and you would like to switch to a Covered California health insurance plan instead of renewing your current plan. 

  • Your provider left the health plan network while you were receiving care for one of the following conditions:

  • Pregnancy

  • Terminal illness

  • An acute condition

  • A serious chronic condition

  • The care of a newborn child between birth and age 36 months

  • A surgery or other procedure that will occur within 180 days of the termination or start date. 

None of the above (Continue to review my application for Medi-Cal/Medi-Cal Access Program) If none of these qualifying life events apply, you should still apply using "None of the above," because you may be eligible for Medi-Cal or the Medi-Cal Access Program (MCAP) for pregnant women based on your income. Regardless of which life event you select, your application will still be reviewed for coverage through Medi-Cal and MCAP.


Source:

Covered California

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