Triggering Events for Special Enrollment Periods

Individuals and enrollees are able to enroll in a QHP or change from one plan to another outside the open enrollment period as a result of the following nine triggering events (also called ‘qualifying events’).

  1. A qualified individual or dependent loses minimum essential coverage
  2. A qualified individual gains a dependent or becomes a dependent through marriage, birth, adoption, or placement for adoption
  3. An individual, who was not previously a citizen, national, or law fully present individual gains such status
  4. A qualified individual’s enrollment or non-enrollment in a QHP is unintentional, inadvertent, or erroneous and is the result of the error, misrepresentation, or inaction of the Exchange or HHS
  5. An enrollee adequately demonstrates to the Exchange that the QHP in which he or she is enrolled substantially violated a material provision of its contract in relation to the enrollee
  6. An individual is determined newly eligible or newly ineligible for advance payments of the premium tax credit or has a change in eligibility for cost-sharing reductions, regardless of whether such individual is already enrolled in a QHP. (The Exchange must permit individuals whose existing coverage through an eligible employer-sponsored plan will no longer be affordable or provide minimum value for his or her employer’s upcoming plan year to access this special enrollment period prior to the end of his or her coverage through such eligible employer-sponsored plan)
  7. A qualified individual or enrollee gains access to new QHPs as a result of a permanent move
  8. An Indian may enroll in a QHP or change from one to another one time per month
  9. A qualified individual or enrollee demonstrates to the Exchange that the individual meets other exceptional circumstances (as defined by the Exchange)

Unless specifically stated otherwise, an individual or enrollee has 60 days from the date of
a triggering event to select a plan

Here’s a chart summarizing the special enrollment period, and open enrollment periods for QHPs in 2014:open_enrollment_periods