Enrollment Periods

A document from a health insurance carrier or government healthcare program, on official letterhead or stationery, demonstrating that at least one of the spouses had minimum essential coverage within the past 60 days,

or

A letter from an employer, on official letterhead or stationery, which confirms one of the spouses had minimum essential coverage through an employer group health insurance plan within the past 60 days.

or

Documentation demonstrating at least one spouse lived for 1 or more days during the 60 days preceding the QE (or during their most recent preceding enrollment period) in a service area where no qualified health plan was available through the Exchange.

The 1^st of the month following receipt of your application

The adoption paperwork or proof of placement for adoption

or

Evidence of proof from a court or state agency that you have the legal right to make medical decisions for a child in foster care

The date of adoption or placement or the 1^st of the month following adoption or placement upon request.

A copy of child support order or applicable court order

The date the court order is effective or 1^st of the month following court order effective date upon request.

See below for required documentation for each loss of coverage event.
*If you apply for a dental plan and want credit applied toward the benefit exclusion periods, you must provide documentation from your employer or prior dental carrier showing the length of your previous dental coverage (i.e., coverage effective date and coverage end date).

The 1^st of the month following the loss of coverage if application is made on or before the day of the life event. If application is made after loss of coverage, 1^st of month following receipt of your application.

Documentation from employer demonstrating the reason for loss of coverage including employment termination date.
*If you apply for a dental plan and want credit applied toward the benefit exclusion periods, you must provide documentation from your employer or prior dental carrier showing the length of your previous dental coverage (i.e., coverage effective date and coverage end date).

The 1^st of the month following the loss of coverage if application is made on or before the day of the life event. If application is made after loss of coverage, 1^st of month following receipt of your application.

Your divorce decree
or
Documentation from appropriate government entity demonstrating termination of domestic partnership.
*If you apply for a dental plan and want credit applied toward the benefit exclusion periods, you must provide documentation from your employer or prior dental carrier showing the length of your previous dental coverage (i.e., coverage effective date and coverage end date).

The 1^st of the month following the loss of coverage if application is made on or before the day of the life event. If application is made after loss of coverage, 1^st of month following receipt of your application.

Either:
A letter from employer on business letterhead confirming loss of coverage
and
A coverage cancellation notice or Certificate of Creditable Coverage
or
A copy of letter from the carrier explaining reason for dependent cancellation.
*If you apply for a dental plan and want credit applied toward the benefit exclusion periods, you must provide documentation from your employer or prior dental carrier showing the length of your previous dental coverage (i.e., coverage effective date and coverage end date).

The 1^st of the month following the loss of coverage if application is made on or before the day of the life event. If application is made after loss of coverage, 1^st of month following receipt of your application.

A coverage cancellation notice or Certificate of Creditable Coverage
and
Documentation or letter from employer on business letterhead confirming the reason for loss of coverage or reduction of hours of employment to less than the number of hours required for eligibility.
*If you apply for a dental plan and want credit applied toward the benefit exclusion periods, you must provide documentation from your employer or prior dental carrier showing the length of your previous dental coverage (i.e., coverage effective date and coverage end date).

The 1^st of the month following the loss of coverage if application is made on or before the day of the life event. If application is made after loss of coverage, 1^st of month following receipt of your application.

A Certificate of Release or Honorable Discharge from Active Duty.
*If you apply for a dental plan and want credit applied toward the benefit exclusion periods, you must provide documentation from your employer or prior dental carrier showing the length of your previous dental coverage (i.e., coverage effective date and coverage end date).

Date of discharge

A coverage cancellation notice or Certificate of Creditable Coverage.
*If you apply for a dental plan and want credit applied toward the benefit exclusion periods, you must provide documentation from your employer or prior dental carrier showing the length of your previous dental coverage (i.e., coverage effective date and coverage end date).

The 1^st of the month following the loss of coverage if application is made on or before the day of the life event. If application is made after loss of coverage, 1^st of month following receipt of your application.

A notification of loss of Children’s Health Insurance Program or Medicaid coverage from state program.
*If you apply for a dental plan and want credit applied toward the benefit exclusion periods, you must provide documentation from your employer or prior dental carrier showing the length of your previous dental coverage (i.e., coverage effective date and coverage end date).

If you lose Medicaid/CHIP coverage you have up to 90 days to enroll in a new plan. Once your application is received, your coverage will start on the 1st of the month following month.

A notification of loss of pregnancy related coverage from Children’s Health Insurance Program or Medicaid coverage from state program.

The 1^st of the month following the loss of coverage if application is made on or before the day of the life event. If application is made after loss of coverage, 1^st of month following receipt of your application

Documentation of from the US Department of Health and Human Services (HHS) on open enrollment application and transfer to Medicaid or CHIP for eligibility review
and
Documentation from Medicaid or CHIP on final ineligibility determination.

The 1^st of the month following the loss of coverage if application is made on or before the day of the life event. If application is made after loss of coverage, 1^st of month following receipt of your application.

Documentation of QHP/QDP decertification from the US Department of Health and Human Services (HHS) or other appropriate government entity.
*If you apply for a dental plan and want credit applied toward the benefit exclusion periods, you must provide documentation from your employer or prior dental carrier showing the length of your previous dental coverage (i.e., coverage effective date and coverage end date).

The 1^st of the month following the loss of coverage if application is made on or before the day of the life event. If application is made after loss of coverage, 1^st of month following receipt of your application.

A coverage cancellation notice or Certificate of Creditable Coverage.
*If you apply for a dental plan and want credit applied toward the benefit exclusion periods, you must provide documentation from your employer or prior dental carrier showing the length of your previous dental coverage (i.e., coverage effective date and coverage end date).

The 1^st of the month following the loss of coverage if application is made on or before the day of the life event. If application is made after loss of coverage, 1^st of month following receipt of your application.

For school-aged children (applying solo), you will need:
A school enrollment record from the former school
and
A school enrollment record for Alaska, Idaho, Oregon or Texas.
For adult applicants & families, you will need:

From both your previous and new address, at least two of the following:

• Utility billing statement and
• Lease or rental agreement or
• Mortgage statement

The 1^st of the month following the permanent move if application is made on or before the day of the move. If application is made after the permanent move, 1^st of month following receipt of your application.

Documentation from employer demonstrating the availability of the group’s annual enrollment period.
*If you apply for a dental plan and want credit applied toward the benefit exclusion periods, you must provide documentation from your employer or prior dental carrier showing the length of your previous dental coverage (i.e., coverage effective date and coverage end date).

Open enrollment when you drop a dependent.
When you choose to change to individual coverage, if application is made before the end of the group’s plan year, the 1^st of the month following group plan renewal date.
Otherwise, the 1^st of the month following receipt of your application.

Documentation of APTC disqualification from the US Department of Health and Human Services (HHS).
*If you apply for a dental plan and want credit applied toward the benefit exclusion periods, you must provide documentation from your employer or prior dental carrier showing the length of your previous dental coverage (i.e., coverage effective date and coverage end date).

Effective 1^st of month following receipt of your application.

Documentation of error from the US Department of Health and Human Services (HHS)
or
Documentation of error from the entity providing enrollment assistance or conducting enrollment activities.
*If you apply for a dental plan and want credit applied toward the benefit exclusion periods, you must provide documentation from your employer or prior dental carrier showing the length of your previous dental coverage (i.e., coverage effective date and coverage end date).

Appropriate date for the special enrollment circumstance, as determined by Moda

Documentation of QHP/QDP material violation from the US Department of Health and Human Services (HHS)
*If you apply for a dental plan and want credit applied toward the benefit exclusion periods, you must provide documentation from your employer or prior dental carrier showing the length of your previous dental coverage (i.e., coverage effective date and coverage end date).

Appropriate date for the special enrollment circumstance, as determined by Moda

Documentation will be determined on a case-by-case basis.

Effective 1^st of the month following receipt of your application.

Employer notice of QSEHRA eligibility and the QSEHRA effective date.
* If you apply for a dental plan and want credit applied toward the benefit exclusion periods, you must provide documentation from your employer or prior dental carrier showing the length of your previous dental coverage (i.e., coverage effective date and coverage end date).

The 1^st of the month when QSEHRA becomes effective if application is made before the day of the life event (or if application made on the day of the life event when falling on 1^st day of a month).
* If application is made on or after QSEHRA becomes effective, 1^st of month following receipt of your application.
* You will only have the opportunity to apply after the life event if your employer did not provide notice of the terms of the QSEHRA at least 90 day prior to the QSEHRA effective date.

Document demonstrating loss of coverage from your employer AND documentation from your employer demonstrating the availability of the group’s annual enrollment period.
*If you apply for a dental plan and want credit applied toward the benefit exclusion periods, you must provide documentation from your employer or prior dental carrier showing the length of your previous dental coverage (i.e., coverage effective date and coverage end date).

The 1^st of the month following the group plan renewal date if application is made on or before the end of the group’s plan year.
Otherwise, the 1^st of the month following receipt of your application.

Employer notice of ICHRA eligibility and the ICHRA effective date.

The 1^st of the month when ICHRA becomes effective if application is made before the day of the life event (or if application made on the day of the life event when falling on 1^st day of a month).
* If application is made on or after ICHRA becomes effective, 1^st of month following receipt of your application.
* You will only have the opportunity to apply after the life event if your employer did not provide notice of the terms of the ICHRA at least 90 days prior to the ICHRA effective date.

Document demonstrating loss of coverage from your employer AND documentation from your employer demonstrating the availability of the group’s annual enrollment period.
*This life event is available for medical plans only. It is not available for dental plans.

The 1^st of the month following the group plan renewal date if application is made on or before the end of the group’s plan year.
Otherwise, the 1^st of the month following receipt of your application.

Document demonstrating the notice of the life event was provided to you untimely and therefore you missed the original special enrollment window.
Other documents required based on the life event listed above.

The earliest effective date that would have been available if timely notice of the life event was received.
Otherwise, the 1^st of the month following receipt of your application