Qualifying Life Events for Special Circumstances

SURVIVORS OF DOMESTIC ABUSE/VIOLENCE OR SPOUSAL/DOMESTIC ABANDONMENT

Dependents of survivors of domestic abuse within a household also qualify for a special enrollment period. If the customer is married to (or in a domestic partnership with) the abuser/abandoner and applying for coverage separately, the customer can indicate on the application that they are unmarried and that they’ll files taxes next year as ‘Single Filing Taxes’ without fear of penalty for misreporting relationship status. They can also be determined eligible for tax credits or cost-sharing reductions.

The event must be reported and a plan selected by the 15th of the month for coverage to start the 1st of the next month. Plan selection must occur within 60 days of reporting the domestic abuse/violence or spousal abandonment.

EXCEPTIONAL CIRCUMSTANCES

These must be defined and approved by the Washington Health Benefit Exchange. The customer, or  their dependent, demonstrates to the Exchange that they meet other exceptional circumstances.

The coverage will begin as determined by the Washington Health Benefit Exchange based on the circumstances.

SYSTEM ERRORS THAT KEPT THE CUSTOMER FROM ENROLLING

  • The system issues must be documented with a ticket;
  • The issue must have occurred during open enrollment or a special enrollment period; and
  • The special enrollment period must be requested within 60 days of the date of the system error.

Coverage will begin the month it would have begun if the customer had not received system errors.

ERRORS OF THE WASHINGTON HEALTH BENEFIT EXCHANGE

This is not related to Washington Healthplanfinder functionality. Enrollment or non-enrollment in a Qualified Health Plan is unintentional, inadvertent, or erroneous, and is the result of the error, misrepresentation, or inaction of an officer or employee of the Exchange.

Coverage will begin based on the circumstances of the special enrollment period.

UNRESOLVED CASEWORK

A customer’s issue didn’t get resolved before the end of open enrollment.

Coverage will begin the month it would have begun if the customer didn’t experience any issues.

CONTRACT VIOLATION BY A QUALIFIED HEALTH PLAN

The customer or their dependents are enrolled in a Qualified Health Plan that violates a provision of its contract.

Coverage will begin based on the circumstances of the special enrollment period.

ERRORS OR OMISSIONS BY AN ENROLLMENT ASSISTOR (NAVIGATOR, BROKER, ETC.)

Misconduct resulted in the customer:

  • Not getting enrolled in a plan
  • Being enrolled in a plan that was not the one they asked to be enrolled in
  • Not getting tax credits or cost-sharing reductions that they were eligible for

Coverage will begin based on the circumstances of the special enrollment period.