Qualifying
Events

What Are Qualifying Life Events for Health Insurance?

Certain qualifying events allow you to enroll in an individual and family plan or change your plan anytime during the year — as long as it's no more than 60 days from the date of a qualifying event. These are the current qualifying events and are subject to change, as determined by the Washington State Office of the Insurance Commissioner (OIC). Kaiser Permanente will review the qualifying event documentation, no matter if you enroll direct from Kaiser Permanente or through the Washington Healthplanfinder.

  • Review the list of qualifying events below to determine if you and your dependents, if applicable, are eligible to enroll outside of open enrollment.
  • If you are eligible for a special enrollment period, review the corresponding document(s) that will be required to be submitted for the qualifying event.
  • See the Submission of Supporting Documentation section below on how to submit the required document(s).

Qualifying Events: Plans Direct from Kaiser Permanente

These qualifying events apply if you purchase a plan direct from Kaiser Permanente

Qualifying Event Document(s) Required
The birth, placement for adoption, or adoption of the applicant for whom coverage is sought. Copy of birth certificate; copy of adoption papers.
The loss of eligibility for Medicaid or a public program providing health benefits. Letter from Medicaid or other program indicating loss of eligibility.
You permanently changed residence which resulted in becoming a resident of Washington or moving to a new county in Washington resulting in having access to new health plan options. Note: A permanent move within the United States to Washington is only a qualifying event if you had minimum essential coverage for at least one day within the 60 days before you moved. Copy of termination letter from prior health plan—must include covered individuals and date coverage was lost. Documentation that shows your prior address that is dated within last 60 days PLUS one additional document, such as a current utility bill, WA Driver's License, voter's registration card, etc. showing your Washington address.
The loss of coverage as the result of dissolution of marriage or termination of a domestic partnership. Copy of divorce decree or annulment papers; a statement (including the date) the domestic partnership ended.
Marriage or entering into a domestic partnership, including eligibility as a dependent. Copy of marriage certificate; state registration or a Declaration of Domestic Partnership.
Loss of minimum essential benefits, including loss of employer sponsored insurance coverage; except for voluntary termination of health coverage, misrepresentation, or fraud. Your COBRA offer letter or a letter from your employer listing each applicant who experienced a loss of coverage and reason for termination.
If coverage is discontinued in a qualified health plan by the health benefit exchange pursuant to 45 C.F.R. 155.430 and the three month grace period (delinquency period) for continuation of coverage has expired. Letter from the Exchange or health plan indicating coverage was discontinued by the Exchange and the three month grace period for continuation of coverage has expired.
Loss of COBRA coverage due to failure of the employer to remit premium. Letter from employer or COBRA administrator indicating loss was due to failure of the employer to remit premium.
The COBRA coverage period ends (usually after 18 months) or the individual has exceeded the lifetime limit in the plan and no other COBRA coverage is available. Note: Voluntary termination of COBRA is not a qualifying event. If you terminate or stop paying for your COBRA, you must wait for the next open enrollment period to apply. Letter from employer or COBRA administrator indicating loss of COBRA coverage was due to individual exhausting the COBRA period or exceeding the lifetime limit in the plan and that no other COBRA coverage is available.
A situation in which a plan no longer offers benefits to the class of similarly situated individuals that includes the applicant. Letter from the prior health plan indicating loss of coverage was due to being in a class of similarly situated individuals.
Loss of coverage as a dependent on a group plan due to age. Letter from employer or health plan indicating loss of coverage was due to age.
If the person discontinues coverage under the Washington State Health Insurance Pool (WSHIP). Letter from WSHIP indicating coverage has been discontinued.

Qualifying Events: Plans Through Washington Healthplanfinder

These qualifying events apply if you purchase a plan through Washington Healthplanfinder.

Qualifying Event Document(s) Required
The birth, placement for adoption, or adoption of the applicant for whom coverage is sought; for qualified health plans (QHPs), also applies to children placed in foster care, legal wards, guardianship, or medical support orders. Copy of birth certificate; copy of adoption papers; copy of foster care papers; copy of medical support order; copy of the court order appointing a guardian.
Loss of minimum essential benefits, including loss of employer sponsored insurance coverage; except for voluntary termination of health coverage, misrepresentation, or fraud. Your COBRA offer letter or a letter from your employer listing each applicant who experienced a loss of coverage and reason for termination.
The loss of eligibility for Medicaid or a public program providing health benefits. Letter from Medicaid or other program indicating loss of eligibility.
The loss of coverage as the result of dissolution of marriage or termination of a domestic partnership. Copy of divorce decree or annulment papers; a statement (including the date) the domestic partnership ended.
Marriage or entering into a domestic partnership, including eligibility as a dependent. Copy of marriage certificate; state registration or a Declaration of Domestic Partnership.
You permanently changed residence which resulted in becoming a resident of Washington or moving to a new county in Washington resulting in having access to new health plan options. Note: A permanent move within the United States to Washington is only a qualifying event if you had minimum essential coverage for at least one day within the 60 days before you moved. Documentation that shows your prior address that is dated within last 60 days PLUS one additional document, such as a current utility bill, WA Driver's License, voter's registration card, etc. showing your Washington address.

Submission of Supporting Documentation

Documentation supporting the qualifying event should be included with your application or sent in as soon as possible so the process of the application is not delayed.

Document(s) should be sent to us via fax or mail:

Fax: 206-877-0655, Attn: I&F Sales

Kaiser Foundation Health Plan of Washington
Individual & Family Sales
320 Westlake Ave. N., Suite 100
Seattle, WA 98109

Note: These qualifying events or status will continue to be verified by the Exchange:

  • You can show the Health Benefit Exchange that your health insurer violated an important provision of its contract with you, such as failing to pay claims for covered health care treatments.
  • You lose coverage due to errors made by the Health Benefit Exchange.
  • You or your dependents have a change in citizenship status.
  • You or your dependents have a change in national or lawful presence.
  • You or your dependents have a change in income or household status that affects your eligibility for tax credits or cost-sharing reductions.
  • You or your dependents have a change in their incarceration status.
  • If you're a Native American, you're allowed to change plans within the Exchange once a month.
  • If you qualify for Medicaid, Washington's Apple Health (Medicaid) enrollment is year-round.