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ObamaCare Qualifying Life Events & Special Enrollment Periods in CA
Qualifying Life Events Triggering Special Enrollment Period (SEP)
Lost or will soon lose my health insurance
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
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
(If you receive a child in foster care, you will also qualify for a special enrollment period but will need to indicate "adopted a child" in the drop-down menu.)
A child is born, adopted or received into foster care. The entire family can use the special enrollment period to enroll in coverage.
If you place your child for adoption or foster care, you can use a special enrollment period to enroll in coverage.
Got married or entered into domestic partnership
One or both members of the new couple can use the special enrollment period to enroll in coverage.
Legal Separation, Divorce or Dissolution of a Domestic Partnership
Returned from active duty military service
You have lost coverage after leaving active duty, reserve duty, or the California National Guard.
Released from jail or prison
Gained citizenship/lawful presence
You become a citizen, national, or permanent legal resident.
Federally Recognized American Indian/Alaska Native
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
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 (please select "Other qualifying life event" in the drop-down menu and "Single" or "Head of Household" in the "Personal Data-Tax Information" section of the application).
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:
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.
Gilroy, California - Serving California Residents Since 1995 California License 0B58920
This web site is owned and maintained by David Fluker Insurance Services, which is solely responsible for it's content. The site is not maintained by nor affiliated with Covered California, and Covered California bears no responsibility for it's content. The e-mail addresses and telephone numbers that appear throughout the site belong to David Fluker Insurance Services and cannot be used to contact Covered California.
For individuals & families who missed open enrollment and do no have a Life Qualifying Event (as listed below), there are other options for coverage.
Medi-Cal (California Medicaid) is available year-round to those whose incomes qualify for enrollment (below 138% Federal Poverty Level). I can help you enroll in MAGI Medi-Cal anytime during the year if you are income-eligible!
MRMIP* (CA Major Risk Medical Insurance Program) has no waiting list and requires a denial letter along with the application for enrollment. Known colloquially as "mister mip" the program offers a PPO from Anthem Blue Cross and HMO from Kaiser Permanente. I can help you enroll and generate the denial letter for eligibility. 10th of the month cutoff for 1st of the next month start dates!
(*Note: MRMIP may be eliminated under Gov. Brown's 2017-18 Budget)
Short-Term Health Insurance for those who qualify (these plans are subject to medical underwriting). Up to three months coverage (as of 4/1/17 per HHS).