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9 Qualifying Reasons for a Special Enrollment Period


1. Involuntary loss of other coverage that is qualified as minimum essential coverage. (Cancelling the plan or failing to pay the premiums does not count as an involuntary loss)

2. Individual plan renewing outside of the regular open enrollment.

3. Becoming a dependent or gaining a dependent as a result of birth, adoption, or placement in foster care. Coverage is backdated to birth, adoption, or placement in foster care.

4. Marriage.

5. Divorce.

6. Becoming a United States citizen. (This qualifying event only applies within the exchanges – carriers selling coverage off-exchange are not required to offer a special enrollment period for people who gain citizenship or lawful presence in the US)

7. A permanent move to an area where different qualified health plans (QHPs) are available. A permanent move to a new state will always trigger a special open enrollment period because each state has its health plans.

8. An error or problem with enrollment (or non-enrollment) that was the fault of the exchange, HHS, or an enrollment assister.

9. Employer-sponsored coverage reduces benefits such that it no longer provides minimum value or becomes unaffordable. (Defined as requiring the employee to pay more than 9.69 percent of income for just the employee’s portion of the coverage in 2017).

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