By Ryan Kennelly
July 13, 2016
Topics:
- Individual & Family Health Insurance
BACK TO BLOGWhat Documentation is Required to Prove a Qualifying Event?
July 13, 2016
- Individual & Family Health Insurance
Some qualifying events have multiple options, but you only need to supply one document. All letters and/or documents should be signed and dated.
In some cases, it is difficult to provide the required documentation (e.g you were / are subletting and do not have a lease or utility bill in your name, etc.). In these circumstances, we can help you prepare an affidavit that might be sufficient for your application depending on the insurance company’s guidelines.
All on-exchange plans purchased through healthcare.gov require documentation of the qualifying event during the Special Enrollment Period. For off-exchange plans, some insurance companies do not require proof of a qualifying event.
| Qualifying Event | Documentation Accepted |
| You or a dependent lose job-based coverage | Letter from employer stating loss of coverage and reason(s) why. Good examples include:- Termination letter from employer or
- Termination letter from previous health plan
|
| You permanently move out of state and gain access to new plans | If you qualify for a Special Enrollment Period because you moved within the last 60 days, you must submit documents that confirm both of these: - You moved to a new primary residence within the last 60 days.
- Proof of residency (from both new and former address) such as a dated utility bill or
- Apartment lease (both new and former address
and 2. You had health coverage at least one day during the 60 days before your move. |
| You get married | |
| You have a baby | - Birth certificate or
- Letter from a medical center showing proof of birth
|
| You adopt a child (or other dependent) | |
| You get divorced (or legally separated from your spouse) | |
| You gain US citizenship | - Naturalization Certificate
- Certificate of Citizenship
|
| Your income changes significantly, making you newly eligible (or ineligible) for subsidies | - Signed affidavit detailing your circumstances
|
| You are or gain status as a Native American Indian | |
| Government enrollment error | - Signed affidavit detailing your circumstances
|
| Release from incarceration | |
If you qualify for a Special Enrollment Period because you moved within the last 60 days, you must submit documents that confirm both of these:
- You moved to a new primary residence within the last 60 days.
- You had health coverage at least one day during the 60 days before your move.
How to Submit Special Enrollment Period Documents
- Log in to your Marketplace account.
- Select “Start a new application or update an existing one.”
- Click on your name in the top right of the screen and select “My applications & coverage” from the dropdown.
- Select the application with the data matching issue under “Your existing applications.”
- Use the menu on the left side of your screen to click on “Application details.”
Note: If you need to send proof for your Special Enrollment Period, you’ll see “Send proof for your Special Enrollment Period.” - For each recent life event you need to prove, select the green “Upload documents” or “Upload more documents.” If there’s more than one, work on them one at a time.
- After selecting “Upload documents” or “Upload more documents,” choose a document type from the drop-down list.
- Click “Select file to upload.” (If you have more than one data matching issue or need to submit documents to prove you’re eligible for a Special Enrollment Period, you can expand or close each one as you work on them.)
- Files must be in one of these formats: .pdf, .jpeg, .jpg, .gif, .xml, .png, .tiff, or .bmp, and can’t be bigger than 10MB.
- The file name can’t include special characters like / \ : * ? “ < > |.
- Locate the document on your computer, select the document, and click “Upload.” When the upload is successful, a checkmark appears next to the file name.
- When the document has been uploaded successfully, “Submitted” appears next to the issue on the “Application details” tab.
Tip: If you can’t scan your document, you can upload a clear photo of it instead
