Special Enrollment Qualifying Events

AddingDependent

ADDING A DEPENDENT

Includes adding a dependent or becoming a dependent through:

  • Marriage
  • Birth
  • Adoption
  • Placement for adoption
  • Placement in foster care
  • Receipt of a court order (including child support)

Coverage start date is the date of birth, adoption, foster care placement, or court order. For marriage, coverage starts the 1st day of the month following plan selection.

LossofDependent

LOSING A DEPENDENT OR DEPENDENT STATUS*

Loss of a dependent or loss of dependent status due to death, divorce, or legal separation.

For loss of a dependent due to divorce, 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. For loss of a dependent due to death, coverage starts the 1st day of the month following plan selection.

*This if for current customers only.

SEP_Taxes

FILED OR RECONCILED TAXES*

If you received tax credits in advanced in the previous year, you must have correctly filed a tax return even if you don’t usually have to file taxes. If you don’t file a tax return and reconcile the tax credit you received, you will lose the opportunity to receive a tax credit until the IRS has confirmed that you have filed your federal taxes.

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.

*This is for current customers only.

ChangeEligibility

CHANGE IN PROGRAM ELIGIBILITY OR AMOUNT OF FINANCIAL HELP*

A change in income or number of household members on the application typically cause your program eligibility to change. If your income changes, you may lose or gain 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.

*This is for current customers only.

LossofMEC

LOSS OF OTHER MINIMUM ESSENTIAL COVERAGE

This includes:

  • Expiration of a non-calendar year health insurance policy, even if the individual has the option to renew
  • Loss of pregnancy-related Medicaid coverage
  • Beginning or ending service in an AmeriCorps, VISTA, or National Civilian Community Corps program
  • Loss of Employer Sponsored Insurance (ESI)
  • Loss of Washington Apple Health (Medicaid)
  • Loss of Washington State Health Insurance Pool coverage (WSHIP)
  • Loss of Qualified Health Plan due to permanent move
  • Loss of employer coverage with eligibility for COBRA or expiration of COBRA coverage

You can enroll in a plan up to 60 days before or after the loss of your other coverage. However, you should wait until the month that your other coverage will end, to avoid having one month of overlapping coverage.

If the loss of other coverage is reported and a new plan selection occurs after the other coverage ends, the new coverage starts on the 1st day of the month after new plan selection occurs. If the loss of other coverage is reported and a new plan selection occurs before the other coverage ends, the new coverage starts on the 1st day of the month after the other coverage ends. For customers who lose Washington Apple Health coverage, their new coverage will automatically start the 1st day of the month after Washington Apple Health coverage ends.

Moved

PERMANENT MOVE

The move results in:

  • Becoming a resident of Washington
  • Moving to a new county in Washington resulting in new plan options

You can enroll in plan up to 60 days before or after the date of the move. A permanent move within the United States to Washington is only a qualifying event if you had minimum essential coverage for at least one day within the 60 days before you moved.

If a plan is selected before the move, coverage starts the 1st day of the month after the move is reported and new plan selection occurs. If a plan is selected after the move, coverage starts the 1st of the next month (if a new plan is selected before the 15th of the current month). If a new plan is selected after the 15th of the month, the coverage will start the 1st of the following month.

 

ChangeinCitizenship

CHANGE IN CITIZENSHIP OR LAWFUL PRESENCE STATUS

An individual, who was not previously a citizen, national, or lawfully present individual, gains such status.

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.

ReleasefromPrison

RELEASE FROM JAIL/PRISON

This is reported as a loss of minimum essential coverage. At least one person on the application has a change in incarceration status (from incarcerated to no longer incarcerated).

If the loss of other coverage is reported and a new plan selection occurs after the other coverage ends, the new coverage starts on the 1st day of the month after new plan selection occurs. If the loss of other coverage is reported and a new plan selection occurs before the other coverage ends, the new coverage starts on the 1st day of the month after the other coverage ends.

TribalMember

TRIBAL MEMBERSHIP

An American Indian/Alaska Native may enroll in a Qualified Health Plan or change from one Qualified Health Plan to another once per month.

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.