Surprisingly, the qualifying events that are acceptable off-exchange vary from one carrier to the next. Be sure to work with a health insurance broker to determine which carriers will accept your qualifying event and which has the best value on health insurance. There is no extra charge for their professional services. Colorado consumers please click here.
Popular Off-Exchange Qualifying Events:
- Renewal of a grandfathered or non-grandfathered individual major medical plan (You often must apply 30 days prior to renewal date).
- Permanently moving to a new area that offers different health plan options.
- Involuntarily losing other health coverage (for example due to a job loss, divorce, loss of eligibility for Medicaid or CHIP, expiration of COBRA coverage, or a health plan being decertified). Please note that voluntarily quitting other health coverage or being terminated for not paying your premiums is not considered loss of coverage. Losing coverage that is not minimum essential coverage is also not considered loss of coverage.
- An individual experienced an error in enrollment.
- An individual adequately demonstrated that the plan or issuer substantially violated a material provision of the contract in which s/he is enrolled.
- An individual became newly eligible or ineligible for advance payments of the premium tax credit or is experiencing a change in eligibility for cost-sharing reductions.
- Return from active military duty.
- Gain of immigration status or citizenship.
- An individual released from incarceration.
Loss of Other Health Coverage (Minimum Essential Coverage) Due to:
- Discontinuation of a current plan that does not meet health care reform requirements
- Legal separation
- Divorce
- Termination of domestic partnership or civil union
- Change in full-time employment status
- Involuntary loss of employer-sponsored insurance
- Death of a parent or spouse
- Change in dependent status as a result of turning 26
Gaining or Becoming a Dependent Due to:
- Marriage
- Domestic partnership
- Birth of child/children
- Adoption of child/children
- Placement for adoption of child/children
- Guardian/court-ordered dependent
