your guide

How does the special enrollment period work?

Special enrollment in District of Columbia

  • You qualify for a special enrollment period if you have a certain life event.
  • You generally have 60 days from the date of your qualifying life event to enroll for health coverage or change your plan.
  • In most cases, you need to have proof of your life event.
  • In some cases, such as loss of coverage, you have 60 days before and 60 days after your qualifying life event to apply for coverage or change your plan.
    • For loss of Medicaid coverage, your health benefit exchange might allow more time. Check with DC Health Link for more details.
  • You may have more than one event. Choose the one with the best plan effective date for you.
  • You may have an opportunity to apply during a special enrollment period for exceptional circumstances if you experience any of the following events. You must choose Determination by your state's health benefit exchange of exceptional circumstances as the qualifying life event.
    • You newly meet the residency requirements to enroll in a health care plan and avoid the tax penalty.
    • Your health plan was terminated due to autopayment failures that were not due to voluntary termination or insufficient funds.
    • You are newly diagnosed as pregnant as confirmed by a health care practitioner.

Tax penalty:

  • There's a District of Columbia mandate that says you must have minimum essential health coverage, or you may have to pay a tax penalty.

2 Choose the qualifying life event that best matches your situation:

If you lose your employer-provided coverage because:


  • You lose your job.
  • Your work hours are reduced, so you no longer qualify for coverage.
  • The person who covers you on an employer health plan dies.
  • You're a dependent on a health plan and your marital status changes due to a legal separation or divorce, so your eligibility as a dependent ends.
  • You no longer live or work in the service area, and no other group health coverage is available to you.
  • You're part of a group of employees that are no longer offered coverage from your employer.
  • A dependent child becomes too old to qualify as a dependent.
  • Your employer stops contributing premium payments for your group health coverage.
  • Your COBRA (Consolidated Omnibus Budget Reconciliation Act) ends.
  • Your retiree coverage is discontinued when your employer declares federal Chapter 11 bankruptcy.
  • The person who covers you on their employer health plan becomes entitled to Medicare.
  • Your group plan is renewing or ending on a date other than January 1.

If you lose Medicaid because:


  • You have a change in income.
  • Your postpartum coverage ends.
  • You lose your pregnancy.
  • You lose what's known as "Medically Needy" coverage, which is special Medicaid coverage for people with too much income or too many assets to qualify for Medicaid, but who have high medical expenses. This type of special enrollment period may occur only once per calendar year.
  • You are otherwise determined to no longer be eligible for Medicaid coverage.

If you lose your Part A, Parts A and B, or Part C Medicare coverage


If you lose individual plan coverage because:


  • Your individual plan is renewing or ending on a date other than January 1.
  • You become ineligible for individual coverage. (For example, this can happen when someone reaches the age limit for being covered as a dependent child.)
  • The person who covers you on their health plan becomes entitled to Medicare.
  • The person who covers you on their health plan chooses employer coverage.
  • You lose certain types of veteran's coverage.
  • You lose TRICARE coverage.
  • You lose certain self-funded student health coverage.

It's NOT a qualifying life event if you lose coverage because:

  • You didn't pay your premiums.
  • Your plan was retroactively cancelled because of fraud or misrepresenting the facts on purpose.
  • You have Medicare Part B coverage and didn't have any other coverage.
  • You voluntarily ended your coverage.
  • You had temporary or short-term coverage like traveler’s insurance.
  • If you got married or registered a domestic partnership

    You have to submit proof of for you or your spouse for at least one full day in the past 60 days unless you were living in an area where no qualified health plan was offered through your state's health benefit exchange. Your state's exchange can tell you if no qualified health plan was available. You may send a screenshot from your state's exchange website or other proof your state's exchange provides.

  • If you have a baby, adopt a child, or a child is placed with you for adoption or foster care.

    If you've had a child in the past couple of months


    If your qualifying event is the birth of a child, you can have your plan start on the date your child was born or on the first day of the month following that date, as long as you apply within 60 days of your child's birth.

    This means you can cover your newborn's care for up to 60 days before you apply for coverage. But keep in mind that if you choose a start date in the past, you'll need to pay the premiums for that time -- plus the standard first month's premium.

    For example, if you have a baby on March 1 and submit your application on April 15, you can ask for March 1 to be your start date, but you'll need to include the premium payments for March, April, and May with your application.

  • If you lose a dependent because the dependent reaches an age where they no longer qualify to be covered under your health plan.
  • For death of the subscriber or a dependent, you may only enroll through your state's health benefit exchange.

If a state or federal court orders that you or your dependent be covered as a dependent.


If your qualifying event is because of a court order to cover a dependent, your plan can start on the date your court order was issued or on the first day of the month following that date, as long as you apply within 60 days of the court order.

This means you can cover your dependent's care for up to 60 days before you apply for coverage. But keep in mind that if you choose a start date in the past, you'll need to pay the premiums for that time — plus the standard first month's premium.

For example, if your court order is dated March 1 and you submit your application on April 15, you can ask for March 1 to be your start date, but you'll need to include the premium payments for March, April, and May with your application.

  • Permanent relocation means moving from a non-Kaiser Permanente service area into a Kaiser Permanente service area and having a different choice of health plans.
  • You moved to a new state.
  • You moved from a foreign country or a United States territory.
  • You moved from a county that did not offer a qualified health plan.
  • You must have minimum essential coverage for all applicants for at least one full day in the past 60 days, unless you moved from a foreign country or a United States territory, or you moved from a county that did not offer a qualified health plan, to qualify based on permanent relocation.
  • You'll also need to provide proof of your old and new residential address.

Note: Your state's health benefit exchange may allow you to apply for coverage up to 60 days before you move. For more information, visit your state's exchange or healthcare.gov or call 1-800-318-2596. You can also call Kaiser Permanente for help at 1-800-494-5314.

  • If your coverage through your employer doesn't qualify as , so you're now eligible for a premium tax credit or there's a change in eligibility for a cost share reduction - for example, if your employer discontinues or changes that coverage.
    You must apply through your health benefits exchange.

If your state's health benefit exchange decides that you qualify for a special enrollment period because of unusual circumstances, such as:

  • A serious medical condition, natural disaster, or other national or state-level emergency that kept you from enrolling during open enrollment,
  • Misinformation, misrepresentation, misconduct, or inaction of someone working in an official capacity to help you enroll (like an health care issuer, navigator, certified application counselor, or agent or broker) that kept you from enrolling in a health care plan, enrolling in the right health care plan or getting the premium tax credit or cost-sharing reduction you were eligible for.
  • A technical error that prevented you from enrolling in a health plan, such as seeing an error message during the online application process.
  • A substantial violation of a material provision of your contract with the health care issuer
  • Or for any other reason as determined by your state's health benefit exchange.

New opportunities to enroll under this qualifying life event include:

  • You newly meet the residency requirements to enroll in health care plan. You have 60 days from the date you meet the residency requirement to enroll.
  • Your health coverage was terminated due to autopayment failures that were not due to voluntary termination or insufficient funds. You have 60 days from the termination date to re-enroll in your qualified health plan to avoid a gap in coverage.
  • You are newly pregnant as confirmed by a health care practitioner. You have 60 days to enroll in a health plan from the date your pregnancy is confirmed.
  • You or your dependent become newly eligible to purchase an individual health plan through an individual coverage health reimbursement arrangement (ICHRA) or a qualified small employer health reimbursement arrangement (QSEHRA) including the date showing when you are first eligible for the ICHRA or QSEHRA.

If you're a survivor of domestic abuse/violence or spousal abandonment occurring within the household and want to enroll in your own health plan separate from your abuser or abandoner, you can enroll by contacting DC Health Link or directly through Kaiser Permanente. Your dependents may be eligible, too.

Even if you're still married to your abuser/abandoner, you can say that you're unmarried on your DC Health Link application -- without fear of penalty for misstating your marital status. Then, if you qualify based on your income, you can get a premium tax credit and other savings on a DC Health Link plan.

  • If your employer or the government recently discontinued its contribution to a continuation to group coverage under COBRA or a similar state program, causing you to lose your COBRA coverage.

If you were recently released from jail, prison, or another form of incarceration, you may only sign up for a plan offered through your state's health benefit exchange

If you're newly entitled to have health care coverage because of an immigration status change. In this case, you may only enroll in a plan offered through your state's health benefit exchange.

For more information, visit your state's health benefit exchange or healthcare.gov, or call 1-800-318-2596. You can also call Kaiser Permanente for help at 1-800-494-5314.

  • Your state's health benefit exchange will decide if you qualify for a monthly special enrollment period to enroll in or change health care coverage. If you do qualify, you may only enroll in a plan through your state's exchange.
  • For more information, visit DC Health Link or call 1-800-318-2596. You can also call Kaiser Permanente for help at 1-800-494-5314.

You must apply through your state’s health benefit exchange. The exchange may require you to submit proof of change in income directly to the exchange.

  • If your household income level changes and, as a result, you or your dependents become eligible — or ineligible — for financial help. (Dependents must be enrolled in the same plan as the subscriber.)
  • If you live in a state that didn't expand Medicaid and aren't enrolled in a Medicaid plan, and you become eligible for an advanced premium tax credit because your household income increases above 100% of the federal poverty level.
  • If a new determination of Medicaid or CHIP ineligibility makes you eligible for health benefit exchange enrollment.
  • You experience a decrease in household income and become eligible for a premium tax credit (APTC) as determined by your state's health benefit exchange.

Note:

  • You must have minimum essential coverage for all applicants from your prior carrier for at least one full day in the past 60 days.

Note: For more information about eligibility for federal financial assistance, visit your state's health benefit exchange or healthcare.gov or call 1-800-318-2596. You can also call Kaiser Permanente for help at 1-800-494-5314.

  • You must apply through your state’s health benefit exchange.
  • You qualify for a monthly special enrollment period if your annual income is expected to be less than 150% of the applicable federal poverty level (FPL).
Back

Need Help? Simply call: 1-800-475-6621 (TTY 711)