Outside of Open Enrollment, you may qualify for Special Enrollment if you have a special life event. These special life events include:
- Moving to a New Address
- Gaining or Becoming a Dependent
- Losing Existing Coverage
- Recently Married
- Becoming a U.S. Citizen
- Complex Issues
Special Enrollment for Complex Issues is for individuals who are unable to enroll in a Marketplace Plan during Open Enrollment for exceptional circumstances. This includes, but is not limited to: incapacitation, natural disasters, domestic abuse and technical errors.
When applying for Special Enrollment, you may be asked to provide documentation to confirm your eligibility. If you are required to provide documentation, you will receive notification during the enrollment process.
Once a qualifying event happens, you will have 60 days to pick a plan. Once you have picked a plan you will have 30 days to submit documentation. Your coverage will begin when you pick a plan, but you will not be able to use your health insurance until your eligibility is confirmed and you have paid your first premium.
Appeal Special Enrollment Eligibility
If you are turned down for special enrollment but believe that you qualify, you may appeal the decision. Once you file an appeal, you will receive a letter that categorizes your appeal as “accepted” or “invalid”.
If your appeal is invalid, the Marketplace Appeals Center is not able to act on your appeal. If your appeal is valid, it will be resolved within 90 days of the request. If you are not satisfied with the resolution of your appeal, you may request a hearing.