You may change or apply for health care coverage during an annual open enrollment period. Outside of the open enrollment period, you have a special enrollment period to
enroll or change your coverage if you experience what’s known as a triggering event. Examples of triggering events include getting married, having a baby, and losing coverage because you lost your job. Even if your triggering event occurs during open enrollment, you will still have a special enrollment period and your coverage effective date may differ from open enrollment effective dates. From the date of your triggering event, the special enrollment period generally lasts 60 days. That means you have 60 days to change or apply for coverage for you and/or your dependents.
What is my effective date?
Your coverage start date will depend on the type of triggering event you experience. Under “Loss of health care coverage,” the date of the triggering event is the 1st day you are uninsured.
What are the triggering events?
The following is a list of all the different triggering events you might experience.
Loss of health care coverage:
You lose your employer-provided coverage for the following reasons:
You lose your job. Your work hours are reduced, so you no longer qualify for coverage.
The person who covers you on his/her employer health plan dies.
You’re a dependent on the plan and your marital status changes due to a legal separation or divorce, so your eligibility as a dependent ends.
You no longer live or work in the service area, and no other group
health coverage is available to you.
You’re part of a group of employees that are no longer offered coverage from your employer.
Your COBRA coverage ends
Your retiree coverage is discontinued when your employer declares federal Chapter 11 bankruptcy.
The person who covers you on his/her employer health plan becomes entitled to Medicare.
Your group plan is renewing or ending on a date other than January 1.
You lose Medicaid. Common examples may include:
You have a change in income
60 days pass after delivering a child, or your pregnancy fails.
You lose what’s known as “Medically Needy” coverage, which is special Medicaid coverage for people with too much income or assets to qualify for regular Medicaid, but who have high medical expenses. This type of special enrollment period may occur only once per calendar year.
You lose your Child Health Plan Plus coverage (CHP+)
You lose Medicare coverage.
You lose individual plan coverage because:
Your individual plan is renewing or ending on a date other than January 1.
You become ineligible for individual coverage. For example, you are a dependent child reaching an age limit.
You become ineligible under the Medical Assistance Act.
Gaining, becoming, or losing a dependent:
You have a baby, adopt a child, get married, register in a civil union, foster a child if your plan includes coverage for foster children or enter in to a designated beneficiary agreement if your coverage includes eligibility for designated beneficiaries.
You lose a dependent because the dependent reaches an age where they no longer qualify to be covered under your health plan, or the subscriber or a dependent dies.
You lose a dependent because of a divorce, dissolution of civil union registration or legal separation.
Court order to cover a child:
Release from incarceration:
Change in eligibility for federal financial assistance:
Your or your dependent’s income level changes and, as a result, you and/or your dependents become eligible — or ineligible — for financial assistance.
Your eligibility to enroll in a health plan with reduced costs (cost-share reduction) changes.