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).
  • Individuals already enrolled on an Individual and Family Plan cannot change metal levels in conjunction with one of the qualifying events below.

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 the official birth certificate, adoption papers, medical support order, or the court order appointing a guardian.
The loss of eligibility for Medicaid or a public program providing health benefits. Copy of the termination letter from Medicaid or other program indicating loss of eligibility and the date of loss.
A permanent change in residence, work, or living situation, whether or not within the choice of the individual, where the health plan under which they were covered does not provide coverage in that person's new service area. If move is within the United States, individuals must have had minimum essential coverage for one or more days during the previous 60 days. This does not apply to those who moved from a foreign country or from a U.S. Territory; however documentation showing move is required. Copy of termination letter from prior health plan—must include covered individuals and date coverage was lost, if applicable. Documentation from the previous and new addresses (i.e. utility bill, Washington driver's license, rental agreement, etc.) dated within the previous 60 days.
The loss of coverage as the result of dissolution of marriage or termination of a domestic partnership. Copy of divorce decree, annulment papers, or affidavit of termination of domestic partnership, and copy of termination letter from prior health plan.
Marriage or entering into a domestic partnership (dependents also qualify). At least 1 partner must have minimum essential coverage at the time of the event or have lived in a foreign country for 1 or more days during the 60 days prior to event. Copy of marriage certificate or domestic partnership registration; documentation showing 1 partner has minimum essential coverage, or documentation showing residence outside the country within 60 days of the event.
Loss of your health coverage, including an employer plan, unless the loss is based on misrepresentation of a material fact affecting coverage or fraud related to the health coverage.
Note: Voluntarily terminating other health coverage or being terminated for not paying premiums will not be considered loss of coverage. Losing coverage that is not minimum essential coverage is also not considered loss of coverage.
For loss of employer group coverage, a copy of the COBRA offer letter or a letter from your employer listing each applicant that experienced a loss in coverage, the reason for the termination, and when the termination occurred. For loss of individual coverage, a copy of the carrier termination letter or Certificate of Creditable Coverage listing each applicant that experienced a loss in coverage and when the termination occurred.
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 health coverage within the past 60 days. This may include events such as but are not limited to:
  • Loss of Employer Sponsored insurance (loss of a job, voluntarily quitting, reduction in hours)
  • Loss of Washington Apple Health (Medicaid)
  • Cancellation of non-group plan (individual health plan)
  • Loss of eligibility for student health plan
  • Loss of employer coverages with eligibility for COBRA or expiration of COBRA coverage

Note: "Loss" does not include voluntary termination of coverage or termination by the insurer due to nonpayment of premiums.
Copy of Certificate of Health Coverage or other documentation from the carrier showing date coverage ended; Copy of employer letter indicating date that coverage was lost due to termination of work or reduction of work or reduction in hours from employer; Copy of COBRA offer letter—letter must show date when employer coverage ended; Notification from Washington Healthplanfinder indicating loss of Medicaid (Apple Health) and the date coverage was lost.
Loss of dependent status as a result of a death, divorce, or legal separation. Copy of the death certificate; copy of divorce or annulment papers; a copy of dissolution of domestic partnership (court papers); copy of legal separation documents.
Marriage or entering into a domestic partnership (dependents also qualify). At least 1 partner must have minimum essential coverage at the time of the event or have lived in a foreign country for 1 or more days during the 60 days prior to event. Copy of marriage certificate or domestic partnership registration; documentation showing 1 partner has minimum essential coverage, or documentation showing residence outside the country within 60 days of the event.
A permanent change in residence, work, or living situation, whether or not within the choice of the individual, where the health plan under which they were covered does not provide coverage in that person's new service area. If move is within the United States, individuals must have had minimum essential coverage for one or more days during the previous 60 days. This does not apply to those who moved from a foreign country or from a U.S. Territory; however documentation showing move is required. Copy of termination letter from prior health plan—must include covered individuals and date coverage was lost, if applicable. Documentation from the previous and new addresses (i.e. utility bill, Washington driver's license, rental agreement, etc.) dated within the previous 60 days.

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: KPIF

Kaiser Foundation Health Plan of Washington
Individual & Family Sales
GNW-C1W-02
P.O. Box 35002
Seattle, WA 98142

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.
  • Filed or reconciled taxes for a year that you received health insurance premium tax credits.
  • Victims of domestic abuse/violence or spousal abandonment and their dependents.
  • System errors that kept individual from enrolling during SEP or Open Enrollment.