Individual health plan special enrollment periods

Temporary special enrollment period (Aug. 27 - Nov. 14, 2014)

If you have premium payment, claims or enrollment issues your health plan purchased through the Washington Healthplanfinder, you may change your coverage during this temporary enrollment period. Note: If you switch to a health plan sold outside of the Washington Healthplanfinder, you will not be able to keep your premium subsidy.

General special enrollment

If you have a qualifying event, you may get a special enrollment period to buy an individual health plan. This means you can enroll in or change your health insurance plan outside the standard open enrollment period. Most special enrollment periods last 60 days from the date of the qualifying event (see below).

Individual health plans - inside and outside the Exchange

Qualifying events for special enrollment periods include, but aren't limited to:

    • You lose your health coverage, including an employer plan or an individual policy (Note: You don't qualify for a special-enrollment period if you voluntarily cancel your health insurance or your insurer cancels you because you don't pay your premium.)
    • You lose Apple Health (Medicaid) because you no longer qualify
    • You permanently move to a new area where your current plan doesn't provide coverage
    • You add a dependent - including giving birth to, adopting or fostering a child
    • The Exchange (www.wahealthplanfinder.org) discontinues your coverage
    • Your employer doesn't pay your COBRA premiums on time
    • Your COBRA coverage period ends (usually 18 months) or you reach the lifetime limit on your COBRA plan
    • Your dependent loses their coverage on your employer plan due to age
    • You get married or enter into a domestic partnership (dependents also qualify), including domestic partnerships that automatically converted to marriage as of June 30, 2014.
    • You get divorced or you end a domestic partnership
    • You discontinue your Washington State Health Insurance Pool coverage
    • Your health plan is no longer offered for sale in Washington state

    Individual health plans - only inside the Exchange

In addition to the above qualifying events for special enrollment periods, if you buy a health plan through the Exchange (www.wahealthplanfinder.org), one of the following may apply:

  • You're a member of a federally recognized Indian Tribe or Alaska Native, then you may sign up or change plans within the Exchange once a month
  • You can show the Exchange that your health insurer violated an important provision of its contract with you, such as failing to pay claims for covered health care treatments
  • You're denied or lose coverage due to errors or inaction by the Exchange
  • You're denied or lose coverage due to errors, inaction or misconduct by enrollment assisters, such as an insurance company, agent or navigator
  • You have exceptional circumstances that prevented you from enrolling, such as an illness, a natural disaster, or you're a domestic abuse victim and you weren't allowed to enroll separately from your spouse
  • You or your dependent become a citizen, national, or obtain legal immigration status
  • You or your dependents have a change in income or household status that affects your eligibility for tax credits or cost-sharing reductions
  • You permanently move into a new coverage area where you have access to additional health plans
  • You experience other changes in circumstances that affect your eligibility, such as you have a change in your employer health plan that makes it unaffordable or inadequate, or you're released from prison

Note: The Exchange and the U.S. Department of Health and Human Services have the authority to create additional qualifying events for special enrollment periods. Contact the Exchange (www.wahealthplanfinder.org) for more information.

Updated 08/26/2014

See also

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