Qualifying Life Events for Special Enrollment

To enroll in coverage outside of the government's open-enrollment period, consumers must experience a qualifying life event (QLE) that makes them eligible for a special enrollment period (SEP). If consumers experience a qualifying life event, they can enroll in a health insurance plan outside of the normal open enrollment period. Most special enrollment periods last 60 days from the date of the qualifying life event. No special enrollment period or QLE is required for Medi-Cal. Many different types of QLEs are described  below.

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Lost or will soon lose my health insurance 
Examples:​​

• You lose Medi-Cal coverage.

• You lose your employer-sponsored coverage.

• Your COBRA coverage is exhausted. Not paying your COBRA premium is not considered loss of coverage.

• You are no longer eligible for student health coverage.

• You turn 26 years old and are no longer eligible for a parent's plan.

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Permanently moved to/within the state

Examples:

• You move from out of state.

• You move with the state and gain access to at least one new health insurance plan.

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Change of household status

Examples:

• A child is born, adopted or received into foster care. The entire family can use the special enrollment period to enroll in a plan.

• Got married or entered into a domestic partnership. One or both members can use the special enrollment period to enroll in a plan.

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Return from active duty military service

Example:

• You have lost coverage after leaving active duty, reserve duty, or the National Guard.

 

Return from active duty military service

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Gained citizenship or lawful presence

Example:

• You become a citizen, national, or permanent legal resident.

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Federally Recognized American Indian or Alaska Native

Example:

• If you are a member of a federally recognized American Indian tribe, you can enroll at any time and change plans once per month.

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Other qualifying life event

Examples:

• You are already enrolled in a Covered California plan and become newly eligible or ineligible for tax credits or cost-sharing reductions.  

• You are already enrolled in a Covered California plan and you lose a dependent or lose your status as a dependent due to divorce, legal separation, dissolution of domestic partnership, or death.

• Misconduct or misinformation occurred during your enrollment, including: 

  • An agent, certified enroller, Service Center representative or other authorized representative enrolled you in a plan that you did not want to enroll in, failed to enroll you in any plan or failed to calculate premium assistance for which you were eligible.  

  • Misrepresentation or erroneous enrollment, including: 

  • Incorrect eligibility determination. This includes if you applied during open enrollment and were initially told you were eligible for Medi-Cal and then later determined not to be eligible for Medi-Cal.

  • The health plan did not receive your information due to technical issues.

  • An error in processing your verification documents resulted in an incorrect eligibility result.

  • Incorrect plan data were displayed when you selected a plan: Data errors on premiums, benefits or copay/deductibles were displayed; incorrect plans were displayed; or a family could not enroll together in a single plan. 

  • Your health plan violated its contract. 

  • Exceptional circumstances occurred on or around plan selection deadlines, including natural disasters and medical emergencies. 

• You received a certificate of exemption for hardship from Health and Human Services for a month or months during the coverage year but lost eligibility for the hardship exemption outside of an open enrollment period.

• You and your dependents, if any, are victims of domestic abuse or spousal abandonment (please select "Other qualifying life event" in the drop-down menu and "Single" or "Head of Household" in the "Personal Data-Tax Information" section of the application).

• You are required by court order to provide health insurance for a child who was been determined ineligible for Medi-Cal and CHIP, even if you are not the party who  expects to claim the child as a tax dependent. 

• You lose “share of cost” Medi-Cal coverage by reaching your share of cost.

• You are a member of AmeriCorps/VISTA/National Civilian Community Corps:  

  • If you entered AmeriCorps or one of the other organizations listed above outside of open enrollment.

  • If you ended your service with one of the organizations listed above.

• You have a non-calendar year health plan (including “grandfathered” and “non-grandfathered” health insurance plan) outside of Covered California that has expired or will soon expire, and you would like to switch to a Covered California health insurance plan instead of renewing your current plan. 

• Your provider left the health plan network while you were receiving care for one of the following conditions:

  • Pregnancy

  • Terminal illness

  • An acute condition

  • A serious chronic condition

  • The care of a newborn child between birth and age 36 months

  • A surgery or other procedure that will occur within 180 days of the termination or start date. 

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