Qualifying
events

Do you qualify to apply outside of open enrollment?

In general, you can only change or apply for health care coverage during the yearly open enrollment period. But is you have a certain type of event in your life, you can change or apply for coverage. This is called a special enrollment period and this period generally lasts 60 days from the date of your qualifying life 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.

  • Application deadline to enroll is the 15th of the month for coverage to start the 1st of the following month. Example: Applied on June 10th, coverage will start July 1st. Applied on June 20th, coverage will start August 1st.
  • Review the Special Enrollment Guide (PDF) for additional information, and see the list of qualifying life events below to determine if you and your dependents, if applicable, are eligible to enroll outside of open enrollment.
  • Complete an application for health care coverage either online or by paper (PDF). Also, complete the Special Enrollment Proof of Triggering Event form (PDF) (if not already completed), and return this form with the required documentation.
  • See the Submission of supporting documentation section below on how to submit the required form and document(s).
  • Individuals already enrolled on an Individual and Family Plan cannot change metal levels in conjunction with one of the qualifying life events below.

Qualifying life events


Qualifying Event Document(s) Required
Loss of health care coverage
Keep in mind, this event does NOT qualify as a qualifying life event if:
  • You're losing coverage because you didn't pay your premiums.
  • Your plan was rescinded.
  • You had Medicare Part B coverage and do not have any other coverage.
  • You voluntarily ended your coverage.

Effective date is the first day of the month after loss of coverage if plan selection occurs before loss. If plan selection occurs after loss of coverage, effective date will be the first of the month following plan selection.

Letter from your employer
  • Letter or other document from your employer stating that the employer dropped or will drop coverage or benefits for you, your spouse, or dependent family member and the date when this coverage ended or will end.
  • Letter or document from your employer stating that the employer stopped or will stop contributing to the cost of coverage and the date when this contribution ended or will end.
  • Letter showing your employer's offer of COBRA coverage or stating when your COBRA coverage ended or will end.

Letter from your insurance or Medicaid or other government programs
  • Letter from your health insurance company showing a coverage end date, including a COBRA coverage end date.
  • Letter from school stating when student health coverage ended or will end.
  • Letter or notice from Medicaid or the Children's Health Insurance Program (CHIP) stating when Medicaid or CHIP coverage ended or will end.
  • Letter or notice from a government program, like TRICARE, Peace Corps, AmeriCorps, or Medicare, stating when that coverage ended or will end.

Other
  • Dated military discharge papers or Certificate of Release, including the date that coverage ended or will end, if you're losing coverage because you're no longer on active military duty.
  • Dated and signed written verification from a producer or dated letter from the insurer, if you are or were enrolled in a non-calendar year plan that's ending, including the date the plan ended.
  • Pay stubs of both current and previous hours if a reduction in work hours caused you to lose coverage.
Permanent relocation
In this instance, you move from a non-Kaiser Permanente service area to a Kaiser Permanente service area, or you move from a foreign country or a United States territory.

Effective date is the first day of the month after move if plan is selected before move. If plan selected after move, coverage start date following the 15th enrollment cut off rule.

Provide this:
Proof of minimum essential coverage for all applicants from your old insurer for at least 1 full day in the last 60 days (applicants moving within the United States only).

And provide any of these — 1 with your old residential address and 1 with your new residential address (no P.O. boxes):
  • Lease or rental agreement.
  • Insurance documents, like homeowner's, renter's, or life insurance policy or statement.
  • Mortgage deed, if it states that the owner uses the property as the primary residence.
  • Mortgage or rental payment receipt.
  • Mail from the Department of Motor Vehicles, like a valid driver's license, vehicle registration, or change of address card.
  • Mail from a government agency to your address, like a Social Security statement, or a notice from Temporary Assistance for Needy Families or Supplemental Nutrition Assistance Program.
  • Your valid state ID.
  • Internet, cable, or other utility bill (including any public utility like a gas or water bill) or other confirmation of service (including a utility hookup or work order).
  • Telephone bill showing your address (cellphone or wireless bills are OK).
  • Mail from a financial institution, like a bank statement.
  • U.S. Postal Service change of address confirmation letter.
  • Pay stub showing your address.
  • Voter registration card showing your name and address.
  • Documents from the Department of Corrections, jail, or prison showing recent release or parole, including a dated order of parole, dated order of release, or an address certification.
  • Naturalization papers signed and dated within the last 60 days or green card, Education Certificate, or visa (if you moved to the United States from another country).
Losing a dependent through divorce, dissolution of domestic partnership, or legal separation Divorce decree, dissolution agreement, or separation agreement with court filing date stamp.
Gaining or becoming a dependent through marriage or domestic partnership

Effective date is the first day of the month following plan selection.

Provide this:
Proof of minimum essential coverage for 1 spouse in the last 60 days from your old insurer (applicants moving within the United States only).

And provide 1 of these:
  • Marriage certificate/license showing the date of the marriage.
  • Official government record of the marriage, including a foreign record of marriage showing the date of the marriage.
  • Official government record, including date of domestic partnership registration.

Gaining or becoming a dependent through the birth of a child, adoption, or placement for adoption

Effective date will be the date of birth, adoption, or placement for adoption.

Birth of a child
  • Birth certificate or application for a birth certificate for the child.
  • Record from a clinic, hospital, doctor, midwife, institution, or other provider stating the child's date of birth.
  • Military record showing the child's birth date and place of birth.
  • Official government record of a foreign birth certificate showing the child's birth date and place of birth.
  • Religious record showing the child's birth date and place of birth.
  • Letter or other document from the health insurance company, like an Explanation of Benefits, showing that services related to birth or after-birth care were given to the child, the mother, or both, including the dates of service.


Adoption
  • Adoption letter or record showing date of adoption, dated and signed by a court official.
  • Court order showing when the order started. It must have a filing date stamp.
  • U.S. Department of Homeland Security immigration document for foreign adoptions, including the date of the adoptions.
Child support order or other court order to cover child - effective date will be date of court order. Signed court order with court filing date stamp.
Change in eligibility for employer health coverage
  • Letter from employer stating change in minimum essential health coverage and showing determination date.
  • Letter or other document from your employer stating that the employer changed or will change coverage or benefits for you or for your spouse or dependent family member, so it's no longer considered qualifying health coverage, and the date when this coverage or benefits changed or will change.

Submission of supporting documentation

During your special enrollment period, you can either apply directly through Kaiser Permanente (by paper application (PDF) or online), or through Washington Healthplanfinder, our state's health insurance marketplace. (If you qualify for and want financial help from the federal government, you must apply through the Washington Healthplanfinder.)

Documentation supporting the qualifying event should be included with your application, along with the Special Enrollment Triggering Event Form (PDF). You have 30 calendar days from the date of the special enrollment period notification letter to send your proof.

Online applications
If you applied directly with Kaiser Permanente online, you can log back into your account and upload documentation.
Note: If you applied through Washington Healthplanfinder, you can upload your documentation here. We CANNOT access any documents that are uploaded to Washington Healthplanfinder.

Paper applications
Mail or fax in the Proof of Triggering Event Form (PDF) and document(s), along with your application (PDF).

Fax: 206-877-0655, Attn: KPIF

Kaiser Foundation Health Plan of Washington
Individual & Family Sales
RCB-C1W-02
P.O. Box 35002
Seattle, WA 98124-3402

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.
  • System errors that kept individual from enrolling during SEP or Open Enrollment.