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SE Mother and ChildSpecial Enrollment Period
Outside of the open enrollment period, you can enroll or change your coverage only if you have experienced a situation known as a triggering event, such as getting married, having a baby, or losing coverage because you lose your job (If you lose coverage because you didn’t pay your premiums or because your plan was rescinded, then you do not qualify for triggering event.).  

A special enrollment period usually lasts 60 days after the triggering event occurs. This means that if you’ve experienced a triggering event, you have 60 days from the day of the triggering event to change or apply for health care coverage for yourself and/or your dependent. If you do experience a triggering event, then a letter from you that confirms the triggering event is needed, which will then be included with your application and first month’s premium.

Triggering Events

  • Gaining or becoming a dependent: You have a baby, adopt a child, get married, or register in a domestic partnership. Placement of a foster-care child is also a triggering event if your plan includes coverage for a foster-care child.
  • Permanent relocation: You moved to a new location and have a different choice of health plans, or you were recently released from incarceration.
  • You lose your employer health plan coverage (other than COBRA) for the following reasons:
    1. You lose your job.
    2. Your work hours are reduced so you no longer qualify for health coverage.
    3. The person who covers you on his/her employer health plan dies.
    4. You are a dependent on the employer’s health plan and your marital status changes due to a legal separation or divorce, so your eligibility as a dependent ends.
    5. You lose eligibility for coverage through your employer because you no longer live or work in the service area, and no other group health coverage is available to you.
    6. You or your dependent meets or exceeds the maximum lifetime benefits of your health plan because of one specific claim.
    7. You are part of a group of employees who are no longer offered coverage from your employer.
    8. A dependent child has a birthday and no longer qualifies as a dependent on his/her parent’s health plan.
    9. Your employer stops contributing premium payments for your group health coverage.
    10. Your COBRA coverage ends.
    11. Your retiree coverage is terminated or substantially eliminated when your employer declares bankruptcy (Chapter 11).
    12. You lose your eligibility for coverage because the person who covered you on the employer health plan becomes entitled to Medicare.
    13. You lose your minimum essential coverage for a reason that isn’t your fault.
  • Court order: A state or federal court orders that you, or your dependent, be covered as a dependent.
  • Change in eligibility for federal financial assistance through Covered California: Your income level changes and, as a result, you qualify or no longer qualify for federal tax credits.
  • Your eligibility to enroll in a health plan with reduced costs (cost-share reduction) changes.
  • Employer health coverage changes: Your employer discontinues or changes your current coverage options so that you become newly eligible for federal financial assistance. Covered California may determine that your special enrollment period begins before your current coverage ends or changes.
  • Immigration status change: You were not previously entitled to enroll in health plan coverage through Covered California because you were not lawfully present in the United States. You may only enroll in a plan offered through Covered California.
  • Coverage as an American Indian/Native Alaskan: Covered California determines that you are eligible for a special enrollment period each month to enroll in or change health plan coverage through Covered California. You may only do this through Covered California.  Determination by Covered California: Covered California determines that you are entitled to a special enrollment period.
  • Misinformation about coverage: Covered California determines that you are entitled to a special enrollment period. You didn’t apply for coverage during the prior open enrollment period because you were misinformed that you had minimum essential coverage.
  • Provider network changes: You were under active care for certain conditions with a provider whose participation in your health plan ended. Examples of conditions include: an acute condition, a serious chronic condition, pregnancy, terminal illness, care of newborn, or authorized non-elective surgeries.
  • Your individual plan, Medicaid, Medicare, or other governmental coverage (but not special Medicaid programs) ends.
  • Your military coverage ended because you returned from active duty.

 

Triggering event confirmation required

If you have experienced a triggering event, then the insurance company will need a letter from you that confirms the triggering event, along with your application and first month’s premium. The letter should include your name and address as submitted on the application, explain the triggering event that occurred, and include the date of the event. By submitting a signed application and a letter, you are confirming that a triggering event occurred.