Special Enrollment Outside of Covered California Open Enrollment

If you missed the open enrollment for the Affordable Care Act (ACA), you’re not alone. Millions of Americans miss the open enrollment period every year. The good news is, there’s no need to panic. You may be eligible for special enrollment if you experience, or have recently experienced, a qualifying life event.

A special enrollment period allows you to enroll during the 60 days following your qualifying event. This way you will not be required to wait until the next open enrollment period.

We’ll help you determine if you qualify for special enrollment, and we’ll show you how to enroll. We’ll also answer frequently asked questions (FAQs) to make the process even easier. Sometimes life circumstances leave you uninsured or change your coverage, and you might not know what to do next. No need to worry — we’ve got you covered.

Qualifying Life Events

A qualifying life event is a change in your life that allows you to enroll in a health insurance plan. Your qualifying life event could be that you got married, had a baby or moved to or within California. Let’s look at some of the most common situations:

  • You entered into or ended a marriage or domestic partnership.
  • You had a child, adopted a child or are fostering a child in your home.
  • Your coverage under your parents ended because you turned 26 or they lost the coverage you were on.
  • You lost your health coverage through your employer, COBRA, Medi-Cal or school.
  • Your income went down, and you are now eligible for assistance to help you buy your insurance.
  • You returned from active duty in the military.
  • You moved to or within the state of California.
  • You became a citizen, national or lawfully-present individual.
  • You are a federally-recognized Alaska Native or American Indian.
  • You were released from jail or prison.

Less common life events may include a change in AmeriCorps status or a court order to provide health insurance for a child. There are plenty of situations that allow you to enroll in affordable health insurance. It may sound overwhelming but don’t worry — Covered California created a videoso you can hear special enrollment explained. If you are still not sure, that’s okay. Here at Health for California Insurance Center, we are ready to talk through your specific situation with you.

How Do I Enroll?

To enroll in a health insurance plan with a qualifying life event, you first need to apply. Once your application has been processed and accepted, you will then be able to enroll. You are officially enrolled once you make your first payment. We’ll cover the steps in more detail below.

1. Apply

Health for California makes the application process easy to understand and even easier to complete. Plus, you can apply online in a few simple steps. We believe that getting health insurance should not be a confusing or frustrating experience. You deserve coverage, so let’s get started.

To apply for health insurance, whether it’s during the open enrollment period or special enrollment period, take the following steps:

  • Get a quote: Start the application process by getting a free quote. Getting a quote takes seconds, and all you need to do is enter your name, birth date, gender and zip code. After you enter this information, you will be taken to a page presenting all the different health care plans you can choose from.
  • Choose a plan: Browse plans and choose a plan with a price and coverage that works for you.
  • Apply: After you pick a plan, you will be taken to a page to start your application. After you click “Apply,” you will be asked if you have a qualifying life event. Select your life event form the list and continue your application. You’ll be asked a few questions about your household and income. The application typically takes about five to 10 minutes to complete.
  • Submit: After completing your application, type your name in the signature box and click “Submit Application.”
  • Wait: We will send you an email after you submit your application. Keep an eye out for this, as it will provide important information and payment instructions.

2. Enroll

You will not be officially enrolled until you make your first month’s payment after you’ve applied. We will guide you through the payment process so you’ll be covered and ready to put your health first.

What About All the Paperwork?

As part of the application process, Covered California uses records of other government agencies to electronically verify your identity, citizenship or immigration status, and your income. If Covered California is unable to verify your information, they will ask you to submit documents to finish processing your application. If this happens, you will be covered for 90 days so you have time to gather and submit the requested documents.

You will need to submit the documents, either by uploading them online, faxing or mailing them, within the 90-day time frame for your insurance to continue. It’s always best to provide documents as soon as possible. You might be asked to provide one or more of the following supporting documents:

  • Proof of income: A pay stub is the most common proof of income. Just make sure it includes your name and is not older than 45 days. Other documents you can use include a copy of last year’s federal tax return if you still have the same income or a signed statement from your employer.
  • Proof of citizenship or lawful presence: This might include a copy of your U.S. passport, certificate of U.S. citizenship or tribal enrollment card. You might provide a combination of documents such as a copy of your U.S. birth certificate and a copy of your driver’s license.
  • Proof of California residency: A copy of your current California driver’s license or identification card might be the easiest way to show residency, but other documents work too. For example, a current California utility bill in your name proves you live in California.
  • Proof of minimum essential coverage: Minimum essential coverage is the minimum coverage you need to avoid a penalty under the ACA. Covered California might request proof of this to make sure you are not already enrolled in a qualified health plan. You can submit a notice of discontinuance from your previous health insurance provider.

What Else Do I Need To Know?

Enrolling in a health plan is easy because you will not be left in the dark throughout the process. Our agents at Health for California will stay in touch, so you know where your application stands and steps you might need to take to complete the process. Our agents are happy to assist you whenever you have questions along the way.

Before we move on, here are tips to keep in mind:

  • Remember you have 60 days: Remember, you must apply within 60 days after a qualifying life event occurs, or you will have to wait until the next open enrollment period. Start early so you can go through the process without rushing.
  • Consider when to enroll: To avoid gaps in coverage, plan ahead. If you enroll by the 15th of the month, your coverage will begin on the first day of the next month. If you enroll after the 15th of the month, your coverage will begin on the first day of the second month.

FAQs

You might still have some questions, and that’s okay. We’ll cover some FAQs below. If you don’t find the answers you need, reach out to us, and we’ll help you choose the best coverage for your situation.

1. Do I Need Proof of My Qualifying Life Event?

Depending on your circumstances, you may be asked to submit documents to prove your qualifying life event. If you need to submit documents, you will receive a notice after you enroll stating which documents you need to submit. Some examples include:

  • You lost your job: If you lost coverage because you lost your job or went to part-time hours, you could send a letter from your employer. The letter must include the company’s letterhead and state that you will be losing coverage and the reason why.
  • You turned 26: You will need to submit a letter from your parent’s employer or health insurance provider stating the cancellation of your coverage. The letter must include your name and date of cancellation.
  • You got divorced: You will need to send a copy of your divorce papers or legal separation papers.
  • You got married: You will need to submit a copy of your marriage certificate or document of a domestic partnership.
  • You moved to or within California: You can send a California driver’s license that shows your new address, a copy of a utility bill, a paystub or another document that provides proof of your new address.
  • You had a baby: Submit a copy of your baby’s birth certificate or social security card application. If your child is adopted or if you are fostering a child, you can send copies of the adoption or foster care papers.
  • You were released from jail or prison: Send a document which shows your name and date, and states when you were released or scheduled to be released from a correctional facility.
  • You became a citizen or gained lawful presence: You can submit a copy of your immigration papers.
  • You are an American Indian or Alaska Native: Send a document on tribal letterhead showing your name and stating your status as a federally-recognized Alaska Native or Amercian Indian.
  • You returned from active duty or military service: Submit a copy of your release documents from a U.S. military branch.

2. What If I Do Not Have the Documents They Need?

If you do not have any of the above documents, you still have options. Covered California accepts a written letter explaining your qualifying life event and the reasons why you do not have the requested documents. You must sign the letter under penalty of perjury. This means you must include the following statements in your letter:

  • Start the letter with this statement: “I cannot obtain a document to verify the qualifying life event.”
  • End the letter with this statement: “I declare under the penalty of perjury, under the laws of the State of California, that what I stated above is true and correct.”

Then, sign your name.

Also, make sure to include other important information in your letter, such as:

  • Your name
  • The date
  • The date coverage was lost or changed
  • The date of the qualifying life event
  • The name of your spouse if marriage was the qualifying life event
  • The name of your child if having a baby, adopting or fostering was the qualifying life event
  • Your previous address and your new address if moving was your qualifying life event

3. What If I Miss the Special Enrollment Period?

If 60 days pass and you didn’t get a chance to enroll, you will have to wait until the next open enrollment period. However, if you are eligible for Medi-Cal or are a federally-recognized American Indian or Alaska Native, you can enroll at any time.

4. What If My Qualifying Life Event Is Not on the List?

If you feel that a unique situation has prevented you from getting the coverage you need, Covered California will listen to your explanation and consider if it’s a special circumstance or not. Examples include:

  • A natural disaster
  • An unexpected hospitalization
  • Temporary cognitive disability
  • An error was made
  • You’re a survivor of domestic abuse

Contact one of our agents, and we’ll help you take the next step.

5. What If I’m Denied Coverage?

If you apply for coverage during the 60 days of the Covered California special enrollment period and receive a letter saying you don’t qualify, don’t lose hope. If you disagree with their decision, you have the right to file an appeal. You might file an appeal under the following circumstances:

  • They did not process your information promptly.
  • They stated your application was not complete.
  • You were denied enrollment into a Covered California health plan.

To file an appeal, you will:

  • Fill out and submit an appeal form
  • Wait for an acknowledgment letter and further instructions
  • Submit additional information if needed
  • Possibly resolve the appeal without a hearing
  • Have a scheduled hearing over the phone or in-person if an informal resolution is not possible

6. Do I Need Health Insurance?

Despite tax penalties, more than 39 million Americans are uninsured. You might be wondering if it’s worth going through the trouble of getting health insurance. Even if you’re never sick or go to the doctor, it is still a good idea to have coverage. Also, you might face a tax penalty which is either $695 per adult or 2.5 percent of your annual household income — whichever is higher.

Changes have been made so that there will no longer be tax penalties in the future. However, these changes do not take effect until the 2019 coverage year. Nevertheless, there is no need to worry that you will lose a lot of money come tax season. You might be eligible for an exemption. Some exemptions include:

  • There were no affordable health care options for you.
  • You do not need to file taxes because you do not have enough income to file taxes.
  • You went without coverage for less than three consecutive months during the year.
  • You experienced financial or personal hardships which prevented you from obtaining coverage.
  • You were incarcerated.
  • You are not a U.S. citizen or lawfully present.
  • You are opposed to accepting health insurance benefits as a member of a religious sect or division.
  • You are a member of a federally-recognized American Indian tribe.

7. Why Should I Get Health Insurance?

Besides avoiding a tax penalty, health insurance is important to have. It brings you peace of mind, and it allows you to take good care of yourself and maintain your health. No one ever plans to get sick or injured, and it’s always comforting to know you’re covered in case something happens. When you have health insurance:

  • You have coverage for illness or accidents.
  • You have protection from expensive medical bills.
  • You get free preventive care even before you meet your deductible.
  • You don’t have to pay the tax penalty.

Health insurance is not just for using when you’re sick. Health insurance helps prevent illness.

8. Does Pregnancy Qualify Me for Special Enrollment?

Pregnancy is not a qualifying life event for the special enrollment period. However, pregnant women have plenty of health insurance options. For example, you might have another qualifying life event like the loss of coverage to use for special enrollment. Or, you might be eligible for a Medi-Cal program, which you can apply for at any time.

Insurance is important for pregnant women, so if you have any concerns or questions about your coverage, do not hesitate to call us for assistance.

9. How Much Does Health Insurance Cost per Month in California?

Health insurance costs vary depending on the individual and their income level. You can get a free quote to help you choose a plan before you enroll. It’s quick, easy and you’ll get to see all your options before you choose.

10. Why Should I Enroll Through Health for California?

We make the enrollment process extremely simple at Health for California, and our services are free. With Health for California, you’ll enjoy the following benefits:

  • All of the plans on our site meet ACA requirements.
  • We get a commission from the health insurance provider, meaning our services are free for you, and our prices are the same as you would pay anywhere.
  • Our mission is to help you apply for health coverage through the California Health Exchange — it’s that’s simple!
  • All of our agents are licensed by the California Department of Insurance as well as Covered California.
  • We offer the easiest way to apply for health insurance in California.

Get Your Free Quote Today

We understand that life happens. We also understand that applying for health insurance can be a confusing and overwhelming experience sometimes. That doesn’t mean you should go without coverage. No matter what your reason has been for not having health insurance, we are here to help. Call us Monday through Friday at 1-877-752-4737 and get on the road towards coverage today!

Sources:

https://www.coveredca.com/individuals-and-families/getting-covered/special-enrollment/
https://www.youtube.com/watch?v=wr51mroPtBA&feature=youtu.be&list=UU0_R-e0XTs307kFUrmxKF8g
https://www.healthforcalifornia.com/covered-california
https://www.coveredca.com/PDFs/SEP-Acceptable-Documents.pdf
https://www.coveredca.com/find-help/faqs/
https://www.coveredca.com/members/file-an-appeal-or-complaint/
https://www.healthcare.gov/sep-list/
https://www.healthcare.gov/why-coverage-is-important/coverage-protects-you/
https://www.healthforcalifornia.com/individual-and-family-quote
https://marketplace.cms.gov/outreach-and-education/downloads/c2c-roadmap.pdf
https://www.healthforcalifornia.com/covered-california
https://www.healthforcalifornia.com/covered-california/document-proofs
https://www.healthforcalifornia.com/covered-california/document-proofs/income
https://www.coveredca.com/documents-to-confirm-eligibility/proof-of-citizenship-or-us-national-status/
https://www.healthforcalifornia.com/covered-california/document-proofs/california-residency
https://www.healthforcalifornia.com/covered-california/document-proofs/minimum-essential-coverage
https://www.healthcare.gov/coverage-outside-open-enrollment/confirm-special-enrollment-period/
https://www.healthforcalifornia.com/covered-california/document-proofs/send-document
https://www.coveredca.com/individuals-and-families/getting-covered/tax-penalty-details-and-exemptions/
https://www.prnewswire.com/news-releases/392-million-americans-missed-the-obamacare-open-enrollment-most-still-have-options-300591494.html
https://www.healthforcalifornia.com/personal-financial-risk-without-healt-insurance
https://www.coveredca.com/individuals-and-families/getting-covered/pregnant-women/
https://www.healthforcalifornia.com/much-cost-baby-2017
https://www.healthforcalifornia.com/about-us
https://www.healthforcalifornia.com/contact-us

Posted: August 22nd, 2014 under Apply with Covered California