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

Wording from HN ONLINE application

Please check the box next to any Qualifying Event(s) that happened within the last 60 days:

  1. The qualified individual, or his or her dependent, loses minimum essential coverage, which could be due to one of the following reasons (not including voluntary termination of your previous coverage or termination due to failure to pay premiums):
    1. The death of the covered employee.
    2. The termination or reduction of hours, of the covered employee’s employment.
    3. The divorce or legal separation of the covered employee from the employee’s spouse.
    4. The covered employee becoming entitled to benefits under Medicare.
    5. A dependent child ceasing to be a dependent child under the generally applicable requirements of the plan.
    6. A proceeding in a case under title 11 bankruptcy, commencing on or after July 1, 1986, with respect to the employer from whose employment the covered employee retired at any time. In this case, a loss of coverage includes a substantial elimination of coverage with respect to a qualified beneficiary (spouse/domestic partner, dependent child or surviving spouse /domestic partner) within one year before or after the date of commencement of the proceeding.
    7. Loss of minimum essential coverage for any reason other than failure to pay premiums or situations allowing for a rescission for fraud or intentional misrepresentation of material fact.
    8. Termination of employer contributions.
    9. Exhaustion of COBRA continuation coverage.
  2. The qualified individual gains a dependent or becomes a dependent through marriage, domestic partnership, birth, adoption, placement for adoption, or the assumption of a parent-child relationship.
  3. The qualified individual’s, or his or her dependent’s, enrollment or non-enrollment in a health plan is unintentional, inadvertent, or erroneous and is the result of the error, misrepresentation, or inaction of an officer, employee, or agent of the Exchange or HHS, or its instrumentalities as evaluated and determined by the Exchange.
  4. The health plan in which the enrollee, or his or her dependent, is enrolled substantially violated a material provision of its contract.
  5. The qualified individual or enrollee, or his or her dependent, gains access to a new health plan as a result of a permanent move.
  6. With respect to individuals enrolled in non-calendar year individual health insurance policies, a limited open enrollment period beginning on the date that is 30 calendar days prior to the date the policy year ends in 2014.
  7. He or she is mandated to be covered as a dependent pursuant to a valid state or federal court order.
  8. He or she has been released from incarceration.
  9. He or she was receiving services under another health benefit plan, from a contracting provider who is no longer participating in that health plan, for any of the following conditions: (a) an acute condition (a medical condition that involves a sudden onset of symptoms due to an illness, injury, or other medical problem that requires prompt medical attention and that has a limited duration); (b) a serious chronic condition (a medical condition due to a disease, illness, or other medical problem or medical disorder that is serious in nature and that persists without full cure or worsens over an extended period of time or requires ongoing treatment to maintain remission or prevent deterioration); (c) a terminal illness (an incurable or irreversible condition that has a high probability of causing death within one year or less); (d) a pregnancy; (e)care of a newborn between birth and 36 months; or (f) a surgery or other procedure that has been recommended and documented by the provider to occur within 180 days of the contract’s termination date, or within 180 days of the effective date of coverage for a newly covered insure, and that provider is no longer participating in the health plan.
  10. He or she demonstrates to the Exchange, with respect to health benefit plans offered through the Exchange, or to the California Department of Insurance, with respect to health plans offered outside the Exchange, that he or she did not enroll in a health benefit plan during the immediate preceding enrollment period available to the individual because he or she was misinformed that he or she was covered under minimum essential coverage.
  11. He or she is a member of the reserve forces of the United States military returning from active duty or a member of the California National Guard returning from active duty service under Title 32 of the United States Code.
  12. Newly eligible or ineligible for advance payments of the premium tax credit, or change in eligibility for cost-sharing reductions.
  13. He or she loses medically needy coverage under Medicaid (not including voluntary termination of your previous coverage or termination due to failure to pay premium).
  14. He or she loses pregnancy-related coverage under Medicaid (not including voluntary termination of your previous coverage or termination due to failure to pay premium).



Enrollment Applications –  Individual  –   Small Group

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