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Covered CA Special Enrollment Rules & Job Aids
Covered CA's List of Special Enrollment Events - More than Direct with an insurance company
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.
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
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.