Covered CA Special Enrollment Rules §6504
only apply to get – enroll – sign up for Health Insurance when it’s NOT Open Enrollment
- Get an instant Quote & Enroll!
- IMHO The simple way to review the Special Enrollment Rules – is the plain English Insurance Company brochures below, rather than reviewing the actual legal code
- Open enrollment for February 2026 Effective Date
- starts 11/01/2025 through 01/31/2026.
- If Enhanced Subsides get passed, we guess that there will be a new special enrollment period???
- Key Details:
#Open Enrollment in California starts 11.1 and ends 1.31 AB 1309 * CA Insurance Code 10965.3 *
- All Tool Kits
- Please note that Medi-Cal enrollment is year round.
- Conditional Enrollment for 90 days when you don’t have all the documents for Covered CA?
Covered CA Special Enrollment Qualifying Life Events #QLE
Covered CA.com
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Get Instant Quotes & Subsidy Calculation Visit our testimonials webpage
Special Enrollment Toolkit Covered CA.com |
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- covered ca.com/special-enrollment
- Please note OPEN Enrollment - those rules are used rather than Special Enrollment options!
- Blue Shield Plain English, Effective Dates & Proof Required for Special Enrollment
- Kaiser
- Blue Shield Special Enrollment Guidelines
Steve’s summary of this page
All our Health plans are Guaranteed Issue with No Pre X Clause
Instant Quote & Subsidy #Calculation
There is No charge for our complementary services, we are paid by the Insurance Company.
- Our Quote Engine Takes all the complexity out of using pencil and paper to figure out the premiums per the Obamacare/ACA rules under CFR §1.36B-3 *
- We are authorized Brokers for Dental, Vision & Covered CA get instant quotes direct and in Covered CA with subsidy calculation for:
- Watch our 10 minute VIDEO that explains everything about getting a quote
Contact Us - Ask Questions - Get More Information
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By submitting the information below , you are agreeing to be contacted by Steve Shorr a Licensed Sales Agent by email, texting or Zoom to discuss Medicare or other Insurance Plans as relevant to your inquiry. This is a solicitation for Insurance
Trump Big Beautiful Bill Changes
- For those with Obamacare plans, Covered CA the new legislation will make it harder to enroll and to retain their coverage.
- ACA marketplace Covered CA policyholders will be required to update their income, immigration status, and other information each year, rather than be allowed to automatically reenroll — something more than 10 million people did this year. They’ll also have less time to enroll; the bill shortens the annual open enrollment period by about a month.
- People applying for coverage outside that period — for instance because they lose a job or other insurance or need to add a newborn or spouse to an existing policy — will have to wait for all their documents to be processed before receiving government subsidies to help pay their monthly premiums. Today, they get up to 90 days of premium help during the application process, which can take weeks.
- Republican lawmakers and some conservative policy think tanks, including the Paragon Health Institute, say the changes are needed to reduce fraudulent enrollments, while opponents say they represent Trump’s best effort to undo Obamacare.
- The legislation also does not call for an extension of more generous premium subsidies put in place during the covid pandemic. If Congress doesn’t act, those enhanced subsidies will expire at year’s end, resulting in premiums rising by an average of 75% next year, according to KFF. See our subsidy webpage.
- insurance news net.com/ new-rules
- 2025 Marketplace Integrity and Affordability Final Rule
Older – Other Special Enrollment Periods SEP
News, Links & Resources
- This Open Enrollment Season, Look Out for Health Insurance That Seems Too Good to Be True
- Why insurers are cutting broker pay for exchange plans
- California Senate Bill 260 (CA SB 260) requires all health plans — to share member contact information with Covered California™ when a member’s health coverage terminates.
Health Insurance unfortunately is very complicated
President Trump February 27, 2017
- Thus, if we haven't simplified and explained in PLAIN ENGLISH what you are looking for:
Find out how, by reading our special enrollment page or email us
VIDEO questions that may come up when you lose their job-based coverage
Permanent Move
#Permanent Move of your home – residence
gives you a Special Enrollment for Health Insurance
- FAQ on “Intends to Reside”
- See module below for more rules on residency
- Exact Codes
CA Residency Guidelines #FTB1031 2023
- See our webpage on lawful presence & public charge
- A California resident is one who is in California for other than a temporary or transitory purpose; or Domiciled in California, but outside California for a temporary or transitory purpose. (ftb.ca.gov).
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In using these factors, it is the strength of your ties and closest connections not just the number of ties, that determines your residency (ftb.ca.gov/)
FAQ’s “Move – New County, State or Back in USA”
- What does “#intends to reside” mean?
- For the purposes of § 155.305(a),”intends to reside” means that an applicant has a present intent to reside where he or she is living, and intends to remain in the Exchange service area where he or she is seeking coverage. Individuals visiting an Exchange service area for a transitory purpose, for example, to attend to a business matter, obtain medical care, or for personal pleasure, do not have a present intent to reside, and do not meet the residency requirement for Marketplace coverage for the Marketplace service area they are visiting.
- Certain individuals who cannot indicate intent, such as children, can establish residency without showing intent to reside. For more information, see Questions 1 and 4 as well as 45 C.F.R. § 155.305(a)(3) and 42 C.F.R. § 435.403.
- Does an individual’s residence change when he or she leaves an Exchange service area temporarily?
- No. An individual who leaves an Exchange service area temporarily with intent to return to the original Exchange service area continues to be a resident for the purposes of Marketplace coverage during the temporary absence.
- Permanent Move S E P
- How does someone qualify for the Permanent Move S E P to enroll in a QHP or change their enrollment in a QHP?
- To qualify for the Permanent Move S E P under 45 C.F.R. § 155.420(d)(7), a QI or his or her dependent must gain access to new QHPs as a result of a permanent move.
- For the purposes of qualifying for this S E P, a move is considered permanent if a
- QI (or his or her dependents) moves and meets the Marketplace residency requirement—as described in Questions 1 and 4 with respect to a new location. An individual who moves to a new location temporarily without an intent to reside there or otherwise meeting the Marketplace residency requirement, including for personal pleasure or to obtain medical care, does not qualify for the Permanent Move S E P.
- Similarly, an individual who moves permanently, but does not gain access to new QHPs as a result of the move, would not qualify for the Permanent Move S E P. For example, this may occur if an individual permanently moves within the same apartment building, neighborhood, town, or county, depending on the QHPs offered in the individual’s service area. regtap.info/FAQ_Residency Permanent Move_SEP pdf
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- Here’s our page on coverage out of country. Do NOT take our summary as Gospel. Read your Evidence of Coverage!
- Get quotes here.
- here are travel policies that you can get.
- How does someone qualify for the Permanent Move S E P to enroll in a QHP or change their enrollment in a QHP?
- Special Enrollment CFR 155.420 (d) (7) as it’s a move to a new region. Get FREE no obligation quotes here.
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- “Federal Qualifying Events, Triggers CFR §155.420
- International and Foreign Visitor Website for full information, enrollment and pricing.
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- insure me kevin.com/how-much-do-health-insurance-agents-earn/
- When is a good time to come by and sign up for open enrollment, for medical insurance?
- Website visitors can set a time for Face to Face, Skype, Facetime or phone by going to our scheduler .
- See the Income Chart /income-chart/
- Subsidies IMHO are all hocus pocus and jiggery pokery, until the day of reckoning when you actually file your taxes. premium-tax-credit-8962/
- subsidies-upheld/
- My income will probably be the same as last year (50K AGI) Can we get this fixed?
- What does Off Exchange mean?.
- Exchange is a term for the entire United States. It means Health Care . gov, Marketplace or Covered CA, where you can get subsidies.
- Off Exchange, means that your not in Covered CA, but direct with an Insurance Company.
- Agent support at no additional charge!
- Pretty much, the rates and benefits in or out of Covered CA are exactly the same. Same crappy networks, etc.
- Due to a lawsuit to end subsidies for enhanced silver, direct is less $$$ if you want a silver plan and are not getting subsidies. our webpage on this. Direct – some of the companies offer plans not available in Covered CA. BUT, they must meet Actuarial Value for the Metal Levels, have essential benefits, be guaranteed issue and no pre X!
Technical Law
#CCR.10 California Code of Regulations
§6504 Special Enrollment Periods Cornel Law
FYI Federal §155.420 Special enrollment periods.
- Health & Safety Code 1399.849 (d)
Virtually the same rules
- The actual law, rules and regulation is just too much to read and for me to try to find official interpretations. If you need the law… see the links above.
- Definitions 155.20]
- lawfully present error, misrepresentation, misconduct, substantially violated a material provision of its contract in relation to the enrollee.
- (7) An enrollee Definition, or his or her dependent enrolled in the same QHP – Qualified Health Plan, is determined newly eligible or ineligible for APTC (Subsidies) or has a change in eligibility for CSR. [Cost Sharing Reductions – Enhanced Silver] RIGHT to change Silver Plans!
- A change in income is not a Qualifying life event. If you select “other qualifying life event,” it puts a hold on the account. In the future, for income changes you need to select “none of the above.” Email dated 03/26/2018 11:57 AM from Covered CA *
- (d) § 155.420 The Exchange must allow a qualified individual or enrollee, and, when specified below, his or her dependent, to enroll in or change from one QHP to another if one of the following triggering events occur:
- (4) The qualified individual’s or his or her dependent’s, enrollment or non-enrollment in a QHP is unintentional, inadvertent, or erroneous and is the result of the error, misrepresentation, misconduct, or inaction of an officer, employee, or agent of the Exchange or HHS, its instrumentalities, or a non-Exchange entity providing enrollment assistance or conducting enrollment activities. For purposes of this provision, misconduct includes the failure to comply with applicable standards under this part, part 156 of this subchapter, or other applicable Federal or State laws as determined by the Exchange.
- 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.
- CMS.Gov 45 CFR on non calendar year renewals – to qualify for Special Enrollment, like COBRA and Grandfathered plans.
Verification of Special Enrollment
Consumers and brokers completing an online application will be notified in the application that Covered California may seek to verify the validity of their self-attested Qualifying Life Event (QLE) in order to be eligible for Special Enrollment.
Covered California will contact a random sample of consumers who enrolled during a Special Enrollment Period (SEP) to request proof of the QLE. If the consumer does not provide acceptable documentation of their QLE within 30 days of the date on the original notice, their coverage can be terminated.
If a consumer is found to have been fraudulently enrolled in a Covered California health insurance plan without a Qualifying Life Event, the broker who assisted the consumer could potentially lose their certification. Brokers don’t risk losing your certification with Covered California and ensure all consumers who attest to having experienced a QLE are able to provide proof that they qualify for special enrollment. February 10, 2021 Bulletin *
- CMS awards $18 million contract to verify special enrollments Modern Health Care 2.2.2018
FAQ
Change more than one time within the 60 day period?
- Question If I lose Employer Coverage, enroll in Cal COBRA or COBRA, but want to get a private – direct individual plan or Covered CA, can I do that, if I decide within 60 days of losing coverage?
- Answer Here’s Blue Shields’ rule
- a qualified individual, enrollee, or his or her dependent shall have 60 days from the date of a triggering event to select a QHP. § 6504. Special Enrollment Periods (f)
- I don’t see anything limiting you to only have ONE choice! It may be difficult dealing with the “Rando’s” that don’t look up the law or rules…
- Question termination of employment….” does that include quitting a job?
- Answer Yes.
- You can double check the actual CA law on the link above for § 6504. Special Enrollment Periods (f)
