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Covered CA's List of Special Enrollment Events

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Proof of Eligibility for Special Enrollment webpage

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If one drops into Medi-Cal qualification and loses their Individual Covered CA coverage,  is that a loss of minimum essential coverage and would allow a SEP – Special Enrollment Period into a new plan?

Please start your research into Special Enrollment Periods by reviewing our main page of California Code of Regulations on Qualifying Events


Code of Federal Regulations § 155.420  (d) The Exchange [Covered CA] must allow a qualified individual or enrollee, and, when specified below, his or her dependent, to enroll in or change from one QHP [Qualified Health Plan] to another if one of the following triggering events occur:

(1) The qualified individual or his or her dependent either:

(i) Loses minimum essential coverage. The date of the loss of coverage is the last day the consumer would have coverage under his or her previous plan or coverage.

§5000 A (f) (1) (C)  Plans in the individual market
Coverage under a health plan offered in the individual market within a State.

See definitions in Publication 974  and Covered CA excerpt

Thank you for contacting Covered California™.

That is correct. Losing coverage is a Qualifying Life event. Here is the link of the Qualifying Life events.

You are already enrolled in a Covered California plan and become newly eligible or ineligible for tax credits or cost-sharing reductions.


Email clarification from Covered CA Broker Support

Hi Steve,

Basically the children lost subsidy eligibility because they actually qualify for Medi-Cal so they were removed from the policy. Unfortunately, even though this would seem to be an involuntary loss of coverage, it’s not considered a Qualifying Event because the children are not losing coverage; [minimum essential coverage] they are merely losing the private insurer coverage they preferred and instead getting state-sponsored Medi-Cal coverage. If later the children are denied Medi-Cal or lose eligibility for Medi-Cal, either situation would be a Qualifying Event. Email dated 9.12.2016 5:01 PM from a major insurance company manager

Adverse selection  a situation where an individual’s demand for insurance is positively correlated with the individual’s risk of loss.



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