Do you qualify?
Individuals experiencing a qualifying event will have a special enrollment period to apply for coverage.
Documentation supporting eligibility needed for the qualifying event. The
documentation is required and must be submitted at the time of application.
An application for coverage due to a qualifying event must be received within 60 days after the qualifying
event. The ability to apply up to 60 days prior to a qualifying event date is limited
to loss-of-coverage qualifying events only.
1
Gains a dependent or becomes a
dependent through birth, foster care,
or adoption.
2
Gains a dependent or becomes a
dependent through marriage or
domestic partnership or registration
3
Your dependent is mandated to
be covered pursuant to a valid
state or federal court order.
4
You or your dependent lost minimum
essential coverage due to termination
of employment, a change in
employment status, or a reduction
in hours of the individual providing
coverage to the dependent
5
You or your dependent lost minimum
essential coverage due to cessation of
an employer’s contribution toward your
coverage, which is not COBRA.
6
Death of the person through whom you
or your child were covered as
a dependent or death of a dependent
on your health plan
7
Loss of coverage under a plan in which
you were covered as a dependent
and the policyholder of the plan now
has entitlement of benefits under
Title XVIII of the Social Security Act
(Medicare).
8
Your dependent child’s loss of
dependent status under the applicable
requirements of the health plan
contract (such as reaching age 26).
9
Loss of coverage or loss of a
dependent due to legal separation,
divorce, or dissolution of
domestic partnership.
10
Loss of coverage under the Access
for Infants and Mothers Program
or the Medicaid Program: Includes
Medi-Cal coverage for pregnancy-
related services, loss of access to
CHIP unborn child coverage due to
birth of the child, Medicaid share of
costs, and medically needed programs
or other government-sponsored
healthcare programs.
11
Loss of HMO coverage benefits
because you no longer reside, live,
or work in the HMO service area.
12
You became a permanent resident of
California during a month outside of
the open enrollment period
13
Return from active military service.
14
Release from incarceration.
15
Victims of domestic abuse or spousal
abandonment: A qualified individual or
enrollee is a victim of domestic abuse
or spousal abandonment, including a
dependent or unmarried victim within
a household, is enrolled in minimum
essential coverage, and seeks to
enroll in coverage separate from the
perpetrator of the abuse
or abandonment