Permanent Move 
Special Enrollment for Health Insurance

10 CCR California  Code of Regulations §6504 Special Enrollment Periods

(9) A qualified individual or enrollee, or his or her dependent, gains access to new QHPs [Qualified Health Plan – Insurance Companies] as a result of a permanent move.   into a new county or the USA  and new coverage [free quotes] is available you can get new healthcare coverage, without waiting for the annual open enrollment as you qualify for a Special Enrollment (Main Page)  as provided by law in:

CFR §155.420 Special enrollment periods

(7) The qualified individual or enrollee, or his or her dependent, gains access to new QHPs as a result of a permanent move;

NEW RULE!!
4.2017 Federal

(7) … and—

(i) Had minimum essential coverage as described in 26 CFR 1.5000A-1(b) for one or more days during the 60 days preceding the date of the permanent move.

See also CA Insurance Code §10965.3 (d) (1

Rating Regions Chart

CA Residency Guidelines Franchise Tax Board Publication # 1031 

FAQ’s CMS 1.19.2016 

CMS Fact Sheet 5.6.2016 – Must have prior coverage – can’t move just to get coverage.

Insure Me Kevin.com 

Email us if you have any questions and we can consult and help you enroll with year around service at no addtional charge.  The Insurance Companies pay us to help you.

Blue Shield  CALIFORNIA RESIDENCY DEFINITION

A resident of California is an individual who

(a) has not established a permanent residence outside of California and

(b) intends to reside in California for at least 180 days of the year following his or her effective date.

These requirements apply whether an application is submitted during open enrollment (OE), or under a special enrollment period (SEP).

These requirements also apply to newborn babies and their parents. For example, if an expecting couple from New York is on vacation and the baby is born in California, the parents are not considered residents of California and the baby is therefore not eligible for a Blue Shield plan. This is because (for practical reasons) the residency of the parents or legal guardians determines the residency of the infant. These requirements apply whether the parents or legal guardians reside outside of California or outside of the country. Regarding surrogate mothers, unless she is claiming parental rights, her residency is irrelevant to determining the residency of the infant. Instead, the residency of the parents or legal guardians is what is important.

Applicants for Blue Shield coverage under a SEP must verify California residency by submitting two examples of documentation from Blue Shield’s SEP checklist. In addition, applicants seeking coverage under an SEP for a permanent move must have had coverage at some point during the 60 days prior to their moving to California. [Citation Needed]

Required Proofs to show you moved

Blue Shield Simplified Guide for Open Enrollment and Proofs for moving 

INFANTS & DEPENDENT CHILDREN (applying solo):

Birth Certificate of the child (Hospital, County, or Government issued only) OR Supportive documentation confirming the adoption or legal guardian status (as applicable)

SCHOOL AGED CHILDREN (applying solo):

 School Enrollment Record from the former state California School Enrollment Record (school aged child)

ADULT APPLICANTS & FAMILIES:

Verification of recent address change, such as a utility billing statement, rental agreement, or mortgage statement from the previous residence  and at least one of the following:

Current utility billing statement confirming the California address

Lease or renter’s agreement

Monthly mortgage statement

Notify Your Marketplace about Your New Address

If you moved this year or are planning to move, you probably have a list of organizations to notify about your new address – like the U.S. Postal Service, utility companies and even the IRS. If you get health insurance coverage through a Health Insurance Marketplace, you should add one more important notification to your list: your Marketplace.

If you are receiving advance payments of the premium tax credit, it is particularly important that you report changes in circumstances, such as moving to a new address, to the Marketplace. There’s a simple reason. Reporting your move lets the Marketplace update the information used to determine your eligibility for a Marketplace plan, which may in turn affect the appropriate amount of advance payments of the premium tax credit that the government sends to your health insurer.

Reporting the changes  promptly will help you get the proper type and amount of financial assistance.  Getting too much premium assistance means you may owe additional money or get a smaller refund when you file your taxes. On the other hand, getting too little could mean missing out on monthly premium assistance that you deserve.

Other changes in circumstances that you should report to the Marketplace include:

  • an increase or decrease in your income, including lump sum payments like a lump sum payment of Social Security benefits
  • marriage or divorce
  • the birth or adoption of a child or other changes affecting the composition of your tax family
  • starting a job with health insurance
  • gaining or losing your eligibility for other health care coverage

Many of these changes in circumstances – including moving out of the area served by your current Marketplace plan – qualify you for a special enrollment period to change or get insurance through the Marketplace. In most cases, if you qualify for the special enrollment period, you will have sixty days to enroll following the change in circumstances. You can find information about special enrollment periods at HealthCare.gov.

The Premium Tax Credit Change Estimator can help you estimate how your premium tax credit will change if you experience a change in circumstance during the year.  HCTT-2016-67

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Blue Shield Residency Verification Form
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Links & Resources

Temporary Plans – if you missed Open Enrollment – or are traveling

Blue Card Program Blue Cross Platinum specimen Policy

Out of Area Services & Blue Card Program

Eligibilty Page 25

Lawful Prescense

Legal Resident of CA

Health Net Proof of Residency Requirements

Medi-Cal Rules

Lexis Nexus Review

Reside in Service Area

Our World Wide Coverage Webpage

International Page

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InsuBuy International Medical Coverage – Instant Quotes & Enrollment

6 comments on “Move – New County, State or Back in USA

  1. I’ve been out of the country since April 1 and plan to continue to be out of the country until at least Sept 1.

    My healthcare plan is $235.28 per month which seems both expensive and pointless while I’m out of the country since there are very little benefits abroad.

    Is it possible to get a retroactive refund on my healthcare for these months and cancel the policy until I’m back in the states?

    • I doubt that your 6 month stay out of country changes anything with your residency.

      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.

      https://www.regtap.info/uploads/library/ENR_FAQ_ResidencyPermanentMove_SEP_5CR_011916.pdf

      So, if you cancel coverage, I don’t see how you would qualify to get coverage when you come back to USA.

      There are travel policies that you can get.

      Here’s our page on coverage out of country. Do NOT take our summary as Gospel. Read your Evidence of Coverage!

      $235/month sounds very low. Must be a bronze plan for a young person. Get quotes here.

      Don’t forget, if you get hurt, sick, ill, kidney disease, cancer, etc. outside the USA, you can always come back and get follow up treatment here. How much does chronic care treatment cost?

      Blue Shield Proofs Required:

      proof required

  2. I lived overseas last year and this year, I was in the US in January for 3 weeks, left and came back last month and moved back

    • Sounds good to me, we just need to have the proofs that you are a new resident in CA. The proofs are listed above and on the Blue Shield simplified guide page 5 # 12. Email or bring to our meeting as many as you can get.

  3. I’m a US Citizen along with my wife and children. We have been living in China the past two years.

    1. How do we get Health Coverage when we come back to the USA?

    2. How do we get a 1095 A or B so we can file our taxes?

    3. What’s this you said on the phone about an exemption?

    • 1. When you will come back, if it’s not Open Enrollment, you would qualify for a Special Enrollment CFR 155.420 (d) (7) as it’s a move to a new region. Get FREE no obligation quotes here.

      2. You don’t need a 1095 A, as your exempt from the mandate and not being in the USA – Service Area, you wouldn’t qualify to buy coverage.

      3. File form 8965 to show that you are exempt from the mandate. Links and instructions are on this page.

      Citizens living abroad and certain noncitizens—
      You were:

      A U.S. citizen or a resident alien who was physically present in a foreign country or countries for at least 330 full days during any period of 12 consecutive months;

      A U.S. citizen who was a bona fide resident of a foreign country or countries for an uninterrupted period that includes an entire tax year; Learn More – 8965 Instructions

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