Qualifying Life Events & Special Enrollment

An individual, under certain circumstances, may apply for coverage due to a qualifying life event (QLE). This is referred to as a special enrollment period (SEP). Documentation supporting eligibility under one of the QLEs listed below is required and must be submitted at the time of application.

Important: To be considered eligible in most cases, your application for coverage due to a QE must occur within 60 days of the QLE.

Important note: An eligible individual or dependent who experiences a loss of minimum essential coverage (MEC), has 60 days prior to and 60 days following the loss of coverage to enroll.*

The specific QLE may apply to your entire family, or only to the person affected. For example, if you had a newborn child, you could enroll the child as an individual effective on the child’s date of birth, or you could enroll your entire family effective on the newborn’s date of birth. Please be aware that the effective date differs based on the QLE. An SEP applies to new contracts and additions to existing contracts due to a QLE.
*Please note: The following is for reference purposes only and is not meant to portray a complete list of all QLE’s that might result in a SEP. Please contact your health plan representative for a current and complete list of QLE’s that apply to your particular circumstance.*

Any loss of eligibility for coverage through Medicare, Medi-Cal, including loss of pregnancy-related coverage and medically-needy coverage, or other government-sponsored health coverage.

Loss of Minimum Essential Coverage does NOT include failure to pay premiums or rescission of prior coverage

Per the federal government and Covered California, a loss of minimum essential coverage (MEC) allows applicants to submit a request for coverage up to 60 days before and after the loss of coverage effective date. This is intended to avoid a coverage gap when switching to the new plan.

*Please note: The preceding is for reference purposes only and is not meant to portray a complete list of all QLE’s that might result in a SEP. Please contact your health plan representative for a current and complete list of QLE’s that apply to your particular circumstance.*