Covered CA Special Enrollment Rules & Job Aids
Covered CA's List of Special Enrollment Events - More than Direct with an insurance company
Plain English, Effective Dates & Proof Required
Exceptions to Individual Mandate
- Application Questions for Special Enrollment
- Change in Income – Only if already enrolled in Covered CA
- Covered CA Job Aid
- Effective Dates – Deadlines
- Error – Material Violation by Insurance Company – Covered CA, etc.
- Loss of Current Coverage MEC
- MD not in Network?
- Move – New County, State or Back in USA
- Newly Married
- zHistorical – Open Enrollment Information
- zSpecial Enrollment pre-4.2017 * CMS 9929 F * Historical
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:
(7) The qualified individual or enrollee, or his or her dependent, gains access to new QHPs as a result of a permanent move;
(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)
CMS Fact Sheet 5.6.2016 – Must have prior coverage – can’t move just to get coverage.
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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
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.
Links & Resources
Temporary Plans – if you missed Open Enrollment – or are traveling
Out of Area Services & Blue Card Program
Health Net Proof of Residency Requirements
Reside in Service Area