Qualifying Events to Apply for Individual Coverage Outside Open Enrollment : Health Shop
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Qualifying Events to Apply for Individual Coverage Outside Open Enrollment

by Carmen Tawney on 05/12/14

Rocky Mountain Health Plans makes it easy for individuals to identify qualifying events, timeline and effective dates for individuals to enroll outside of open enrollment period.

Qualifying Event

  • Involuntary loss of creditable coverage for any reason other than fraud, misrepresentation, or failure to pay premium
  • Individuals experiencing a plan renewal
  • Individual gains a dependent or becomes a dependent through;
    • Marriage / Civil Union
    • Birth
    • Adoption or placement in foster care
    • Court Order
    • Entering into a Designated Beneficiary agreement
  • Enrollment or disenrollment is unintentional, inadvertent, or erroneous and is the result of an error. The error must have been made by a Carrier, Producer, or Connect for Health
  • Loss of eligibility for Medicaid or CHP
  • Colorado.
  • Demonstrating to the Colorado Insurance Commissioner that the health plan violated part of its contract
  • Becoming eligible or ineligible for tax credits or cost share reduction-For members enrolled in Connect for Health Colorado
  • Gaining access to other creditable coverage as a result of a permanent change in residence
  • Gain citizenship or immigration status
  • American Indians / Native Americans may enroll in a new plan or change from one QHP to another once a month

Time Line

  • Within 60 days of the event or 30 days in advance with the exception of:
    • Plan Renewal - 30 day Special Enrollment Period prior to the plan renewal date
Effective Date
  • First of the month following receipt of application with the exception of:
    • Birth / Adoption / Foster Care - Effective date will be date of birth, adoption, placement of adoption or placement of foster care
What Documentation is Needed
  • The following documentation is required with your application
    • Adoption - Placement paperwork
    • Court Order - Court ordered paperwork
    • Designated Beneficiary - Designated Beneficiary Form
*More information may be required at request

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