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Covered California Q&A

Covered California and Obamacare related questions from consumers, employers and agents are answered by Phil Daigle with the best information available at the time. Archived entries may no longer be accurate as the Covered California and Obamacare knowledge-base is evolving quickly. TO REQUEST A PERSONAL RESPONSE INCLUDE EMAIL ADDRESS.


Special Enrollment Qualifying Events List

By on | 7 Comments

Question: If I do not sign up with Covered California during the open enrollment period, what happens if I want to enroll later?

Answer: There are certain qualifying events that must be met in order to be eligible for special enrollment (outside open enrollment) in Covered California. The length of the special enrollment window is 60 days after the qualifying event. If you do not meet one of these qualifying events, you must wait until the next open enrollment period. Here is a list of qualifying events that will trigger a special enrollment> Special enrollment periods triggered by:

  1. A qualified individual or a dependent’s loss of Minimum Essential Coverage;
  2. A qualified individual gains a dependent or becomes a dependent;
  3. An individual not previously a U.S. citizen, U.S. national or lawfully present gains such
  4. status;
  5. A qualified individual’s enrollment or disenrollment in a Covered California Plan (CCP) is unintentional, inadvertent, or erroneous as a result of an error, misrepresentation, or inaction of the staff or instrumentalities of Covered California or Health and Human Services. In such cases, Covered California takes necessary actions to correct or eliminate the effects of an identified determination error, misrepresentation or inaction.
  6. An enrollee adequately demonstrates that a CCP substantially violated a material provision of its contract in relation to the enrollee.
  7. An enrollee is determined newly eligible or newly ineligible for advanced premium tax credit (APTC) or has a change in eligibility for CSR;
  8. An individual whose existing coverage through an eligible employer-sponsored plan will no longer be affordable or provide minimum value.
  9. A qualified individual or enrollee gains access to new CCPs as a result of a permanent move; also applies to individuals recently released from incarceration.
  10. A qualified individual who is an Indian may enroll in a CCP or change to another from one time per month.

Initial Open Enrollment Period - October 1, 2013 through March 31, 2014 Subsequent Open Enrollment Period - October 15 through December 7 annually

7 Comments

How does divorce or legal separation affect obtaining or changing coverage during a non-open enrollment period?

Somewhere around 60 days should work.

phil,

have several clients who are out of the country now, returning after open enrollment.

they are US citizens, don’t see anything in the list you cite that clearly points to qualifying as an SEP, though I’ve heard from CovCA that they do. My question is, if they do, then what is the time frame when they can apply so they can have coverage in place immediately upon return? they all have addresses here in CA.

glad you’re setting up as the expert in so many areas. thanks.

bett

Is covered california a event that I can cancel my employer insurance My employer is really expensive but I can’t cancel until open enrollment or have a event. We already meet the requirements for covered California when I signed up for employer insurance it was my only option at the time.

I am currently on COBRA. Is the end of my COBRA benefits a “qualifying event”?

Nope. October 15 through December 7, 2014 and beyond is correct. The reason for the Dec 7th cut-off is to allow time to get all new enrollments and plan changes processed in time for January 1 effective dates.

Hi Phil,

I think subsequent open enrollment periods will be Oct. 1 to December 31. Is that correct? Thanks.

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