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Qualifying Events


You might still be eligible for special enrollment if you've had one of the following qualifying life events.

  • Involuntary loss of individual or group coverage except for failure to pay the premium
  • Marriage or state registered domestic partnership*
  • Birth, adoption, placement for adoption or foster care of a child
  • Qualified Medical Child Support Order (QMCSO)
  • Acquisition of legal guardianship
  • Permanent move to a new PHP service area that offers different health plan options
  • Loss of coverage as a dependent due to age
  • Loss of coverage due to end of marriage or state registered domestic partnership*
  • Involuntary loss of Medicaid or CHIP coverage
  • Newly eligible for a state- or federal- sponsored premium assistance program
  • Loss of Advance Premium Tax Credit (APTC) or Cost Sharing Reductions (CSR), or cessation of employer contribution to COBRA
  • Survivor of domestic abuse/violence or spousal abandonment and wants to enroll in a health plan separate from the abuser or abandoner
  • Newly gains access to an individual coverage HRA (ICHRA) or is newly provided a qualified small employer health reimbursement arrangement (QSEHRA)


*Oregon: A Domestic Partner must be a member of the Policyholder’s same sex, 18 years of age or older, and must have legally registered a Declaration of Domestic Partnership and obtained a Certificate of Registered Domestic Partnership in accordance with Oregon state law.

*Washington: "State registered domestic partners" means two adults who meet the requirements for a valid state registered domestic partnership as established by RCW 26.60.030 and who have been issued a certificate of state registered domestic partnership by the secretary.

Please note: Our acceptance of premium is not a guarantee of coverage. If you are applying directly, Providence Health Plan can request proof of your qualifying event. If applying through the Marketplace, they may also request documentation. If you enroll under special enrollment and later it is discovered you cannot prove the qualifying event, your coverage may be cancelled.



Oregon residents:

Open enrollment for 2023 Individual and Family plan coverage ended January 15, 2023; however, you can apply for and get health insurance coverage during a Special Enrollment Period if you experience certain life events. See the list above for the qualifying life events.

Oregon policyholders may obtain coverage due to a special enrollment qualifying event by submitting an application for coverage to either Providence Health Plan or the Federal Health Insurance Marketplace at HealthCare.gov within 60 days of the qualifying event.



Washington residents:

Open enrollment for 2023 Individual and Family plan coverage ended January 15, 2023; however, you can apply for and get health insurance coverage during a Special Enrollment Period if you experience certain life events. See the list above for the qualifying life events.

Washington policyholders may obtain coverage due to a special enrollment qualifying event by submitting an application for coverage to Providence Health Plan within 60 days of the qualifying event.

  • When the qualifying event is birth, adoption, placement for adoption or foster care of a child, or court order; coverage will be effective from date of birth, adoption, placement for adoption or foster care of a child, or court order, provided your completed application and initial premium payment are received within 60 days of birth, adoption, placement, or court order.
  • For all other special enrollments, coverage will be effective the first day of the month per the application and effective dates table indicated below provided that Providence Health Plan receives timely payment of your initial premium.


If your application is not completed within 60 days of the special enrollment qualifying event, it will expire and you will no longer be eligible for special enrollment.

Questions? For help choosing an Individual and Family plan, please contact our Sales team at 503-574-5000 or 800-988-0088 (TTY: 711), Monday through Friday 8 a.m. to 5 p.m. (Pacific Time). For Federal Health Insurance Marketplace questions, visit HealthCare.gov or call 800-318-2596.

 

Application and effective dates are as follows:


Your Effective Date of Coverage will be the first day of the month following the submission of your completed application, contingent on timely payment of your initial premium payment. Please see examples below.

Date application is received Effective date of coverage Due date for your initial premium payment
(Refer to your offer of coverage for more information)
Special Enrollment
Example: We receive your application between March 1 -31. Example: Your coverage will start on April 1st. Within 15 days after the effective date of coverage or within 30 days after the date of our offer of coverage and initial payment request, whichever is later.
Example: We receive your application between April 1 -30. Example: Your coverage will start on May 1st. Within 15 days after the effective date of coverage or within 30 days after the date of our offer of coverage and initial payment request, whichever is later.