Special Enrollment

Special enrollment due to a qualifying event

Special enrollment guidelines apply when you sign up for a plan outside of the annual open enrollment period, typically November 1 through January 15. To enroll outside of these dates, you must have experienced a qualifying life event, also known as a qualifying event.  As part of the application process, you'll be asked to provide proof that you're a Washington state resident. Your completed application and supporting documentation must be received within 60 days of the life event. In addition to the requirements listed, you may be asked to provide additional documentation of your life event.

Do you qualify?

You'll have to show proof that you've had a qualifying life event, such as losing employer-sponsored coverage or adding a baby to your plan.

As part of the application process, you'll be asked to provide proof that you're a Washington state resident. Your completed application and supporting documentation must be received within 60 days of the life event. In addition to the requirements listed, you may be asked to provide additional documentation of your life event.

Qualifying events

Adding a dependent

Qualifying life events:

• Gaining access to an Individual Coverage Health Reimbursement Arrangement (ICHRA) through your employer
• Marriage or domestic partnership
• Birth, adoption, or placement for adoption
• Foster care or binding court order
• Legal ward or guardianship

Examples of required documents:

• Copy of marriage certificate or state registration document
• Copy of declaration of domestic partnership
• Copy of birth certificate, adoption papers, foster care papers, medical support order
• Copy of guardianship appointment

Losing a dependent

Qualifying life events:

• Loss of coverage as a dependent as a result of death or divorce or termination of a domestic partnership
• Reaching age 26

You will need a verification letter from your health plan showing proof that minimum essential coverage was lost AND appropriate documentation:

• Copy of death certificate
• Copy of divorce decree or annulment papers
• Affidavit of termination of domestic partnership

Loss of minimum essential coverage

Qualifying life events:

• Loss of COBRA coverage
• Loss of employer-sponsored coverage
• Loss of coverage due to a permanent move
• Loss of coverage on Medicaid or another public program

Examples of required documents:

• Letter from your prior health plan company showing proof that your coverage was lost and the reason for termination
• Letter from your employer stating that your coverage was lost and the reason for termination
• COBRA letter indicating loss of coverage and reason for termination
• Copy of utility bill at your new permanent address or rental or lease agreement showing prior address and new address

Other qualifying life events

There are a variety of other qualifying events that may allow you to enroll in coverage during a special enrollment period. These include:

• Being enrolled in a non-calendar year plan that is ending outside of open enrollment
• Change in your eligibility for tax credits and/or cost share reductions
• System or human errors by your state or federal health plan
• Late eligibility

Contact customer service for more information and to see if your specific situation qualifies.