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:
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 from your insurance or Medicaid or other government programs
Choose if one of the following applies to you:
*You have to submit proof of prior coverage for all applicants from your old insurer for a least one full day unless you were living in an area where no qualified health plan was offered through your Marketplace. Your state’s Marketplace can tell you if no qualified health plan was available. You may send a screenshot from the Marketplace website or other documentation the Marketplace provides.
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.
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):
|Gaining or becoming a dependent through marriage or domestic partnership
You have to submit proof of prior coverage for one spouse for at least one full day unless you were living in an area where no qualified health plan was offered through your Marketplace. Your state’s Marketplace can tell you if no qualified health plan was available. You may send a screenshot from the Marketplace website or other documentation the Marketplace provides.
Effective date is the first day of the month following plan selection.
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:
Gaining or becoming a dependent through the birth of a child, adoption, foster care, or placement for adoption or foster care
Effective date will either be the date of birth, adoption, foster care, or placement for adoption or foster care OR the first of the month following the event date.
|Birth of a child
Adoption or foster care
|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||
|You're now eligible for a premium tax credit because your coverage through your employer has changed||
|Change in eligibility for federal financial assistance through Washington Healthplanfinder||
|Determination by Washington Healthplanfinder||
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.
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.
Fax: 206-877-0655, Attn: KPIF
Kaiser Foundation Health Plan of Washington
Individual & Family Sales
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.
- 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.