Individual/Family and Group health coverage sold in California only allows new membership during an annual open enrollment period. Enrollment works this way because if people were allowed to purchase insurance anytime, people could wait until they got sick and the system wouldn't work.
There are exceptions to the annual open enrollment period. These are called qualifying life events and if you experience one or more of them, you can buy new coverage or change your existing coverage. Below is a list of the qualifying life events:
- Gaining a dependent or becoming a dependent through birth or adoption
- Getting married
- Applicant or dependent lost minimum essential coverage due to termination or change in employment status
- Cessation of an employer's contribution toward an employee or dependents coverage
- Death of the person through whom the applicant was covered
- Entitlement of benefits of the subscriber under Title XVIII of the Social Security Act (Medicare), resulting loss of coverage to the dependents
- Dependent child's loss of dependent status under the applicable requirements of a group plan, such as reaching age 26
- Loss of minimum essential coverage excluding the loss of termination due to failure to pay premiums or situations allowing rescission
- Gains a dependent or becomes a dependent through marriage or partnership
- Dependent is mandated to be covered pursuant to a valid state or federal court order
- Legal separation or divorce through whom the applicant was covered as a dependent
- Loss of coverage under the Access for Infants and Mother's Program and Medicaid share of cost program
- Loss of HMO coverage benefits as the individual no longer lives or works in the HMO service area
- Applicant became a permanent resident of California during a month outside of open enrollment period
- Applicant returns from active military duty
- Applicant is released from incarceration
If you have questions about your particular circ*mstance, contact our Consumer Hot Line and we'll help you find the right answer.
