Special enrollment and qualifying events
Open enrollment for 2021 individual and family plan coverage ended December 15, 2020; however, you can apply for and get health insurance coverage during the special enrollment period if you experience certain life events. See the list below 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 Healthcare.gov Marketplace within 60 days of the qualifying event.
The Open Enrollment period for Washington has been extended to January 15, 2021. Those who enrolled in a plan by December 15, 2020 will have a coverage start date of January 1, 2021. Those who enroll after that deadline and before January 15, 2021 will have a coverage start date of February 1, 2021. After January 15, 2021, Washington policyholders may obtain coverage due to a special enrollment qualifying event.
The effective date of coverage is determined by the qualifying event as well as the receipt of the initial premium:
- When the qualifying event is birth, adoption, placement or court order; coverage will be effective from date of birth, adoption, or placement for adoption or foster care, provided your completed application and initial premium payment are received within 60 days of birth, 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.
- Involuntary loss of individual or group coverage except for failure to pay the premium
- Marriage or 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 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)
- Survivor of domestic abuse/violence or spousal abandonment and wants to enroll in a health plan separate from the abuser or abandoner
- Denial of Medicaid or CHIP eligibility determined after open enrollment ended or more than 60 days after a qualifying event
- 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: A Domestic Partner must be at least 18 years of age. They must be a member of the Policyholder’s same sex, unless one of the partners is at least 62 years of age, and they must have legally entered into a State Registered Domestic Partnership and obtained a Certificate of State Registered Domestic Partnership in accordance with Washington state law.
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 or WaHealthPlanFinder, 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.
Application and effective dates are as follows:
The Effective Date of Coverage is determined by the date of your completed application as well as the date Providence Health Plan receives the initial Premium. See table below:
Date we receive your application
Effective date of coverage
Due date for your initial premium payment
|1st – 15th of the month
Example: We receive your application on March 12th.
|1st day of the following month
Example: Your coverage will start on April 1st.
|Within 15days 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.|
|16th – last day of the month
Example: We receive your application on March 28th.
|1st day of the 2nd following month
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.|