Other Covered CA Qualifying Life Events

You might be having trouble finding a qualifying life event that applies to you. If so, look over the following scenarios carefully. The situations found in the “other qualifying life event category” are generally less common but can, nevertheless, qualify you for special enrollment. Keep in mind that in all of these cases, the life event must have occurred in the last sixty days in order for you to qualify.

If you’re not sure about whether any of these apply to you, please feel free to give one of our agents a call. We’d life to assist you in this process.

New Eligibility

Usually if you want to switch plans you’d have to wait for open enrollment. However, if you are already enrolled in a Covered California plan and something in your life changes, making you eligible to tax credits or cost sharing reductions, you may qualify for special enrollment.

On the other hand, if you are already enrolled in a Covered CA plan and something in your life changes, making you ineligible to tax credits or cost sharing reductions, you may qualify for special enrollment.

Misconduct or Misinformation

During open enrollment some customers reported that they had negative experiences with their agent, enrollment counselor, or Covered CA service center representative. If you were in a position where you tried to enroll through one of these and, at no fault of your own, your enrollment was not successfully processed, you may qualify for special enrollment.

Some examples would include:

  • You applied through an enrollment counselor but were enrolled in the wrong plan.
  • You applied with a service center representative but they failed to enroll you at all.
  • You applied with an authorized representative but they failed to calculate the premium assistance you qualify for.
Misrepresentation or Erroneous Enrollment

If you attempted to enroll in a Covered CA health plan during open enrollment but experience one of the following situations, you may qualify for special enrollment.

Incorrect Eligibility Determination
  • For example, when you applied you were told you qualified for Medi-Cal and it was determined later that you actually don’
Technical Issues
  • For example, you did everything that was asked of you during the enrollment process yet, due to technical issues, the carrier never received your information from Covered CA.
Immigration Document Processing
  • For example, you did everything that was asked of you during the enrollment process but an error in processing your immigration documents led to incorrect eligibility determination.
Covered CA Displayed Incorrect Plan Data
  • For example, you selected a plan to discover later that Covered CA had displayed incorrect information for your desired health plan.
  • Or, you were given the wrong set of plans to choose from.
  • Or, your family was unable to enroll in a single plan.
Health Plan Contract Violation

If you’re currently enrolled in a health plan and discovered that your carrier violated it’s contract, you are eligible for special enrollment.

Natural Disaster

If exceptional circumstances occurred on or near a plan selection dealing you may qualify for special enrollment.

Medical Emergency

If you experienced a medical emergency on or near a plan selection deadline you may qualify for special enrollment.

COBRA Eligibility

If you’ve recently become eligible for COBRA because you lost your employer-sponsored insurance, you have two options.

  1. You can choose coverage under COBRA
  2. You can use a special enrollment period to purchase a Covered CA health plan