Major life events, or a change in household income, may change your eligibility for healthcare programs and financial help through Vermont Health Connect. Some life changes let you have a Special Enrollment Period (SEP). This is the only time you can sign up for new coverage or change plans outside of Open Enrollment. The below list is an overview of life events that qualify/do not qualify Vermonters to enroll in health plans offered by Vermont Health Connect.
If you have any questions or need to change an existing application, please call Customer Support at 1-855-899-9600.
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Key terms defined
- Plan Confirmation - The date when Vermont Health Connect confirms that you are enrolled in a health insurance plan. This happens after you apply, choose a plan, and confirm that you have signed up for a health insurance plan.
- Plan Effective Date - The date when the health insurance plan and its benefits start. For example, if a plan has an effective date of February 1, it means coverage begins on that date. However, you must pay the premium for coverage to start.
Open Enrollment and Ongoing Enrollment Opportunities
Open Enrollment runs each year from November 1 through January 15. To enroll in a health insurance plan any other time, you must meet certain rules. If you do, you get a Special Enrollment Period. Some kinds of Special Enrollment Periods are for certain life events. This includes marriage, divorce, having or adopting a child, or losing health care.
You can enroll in or change a Qualified Health Plan at any time during the year IF:
- Your household income is at or below 200% of the Federal Poverty Level AND
- You meet certain rules to get financial help (subsidies) to pay for the plan.
When will your coverage start?
- Must confirm plan by the 15th of the month:
- Coverage starts the 1st day of the next month.
- Applicants who confirm their plan from the 16th of the month to the end of the current month:
- Coverage starts the 1st day of the second month.
Example:
Plan Confirmation: August 20
Plan Effective Date: October 1
Are you currently directly enrolled in coverage through Blue Cross and Blue Shield of Vermont or MVP Health Care? Eligible customers can transfer a plan to Vermont Health Connect and take advantage of tax credits to help pay for health coverage. This is not considered a Special Enrollment Period. For more information, see the instructions for direct enrolled customers.
Loss of Coverage
The Affordable Care Act is the federal health insurance law. It says what health insurance plans must cover. To meet the law, plans must offer certain things called minimum essential coverage. Examples of plans that meet this are:
- Marketplace plans;
- Employer-Sponsored Insurance, or ESI;
- Medicare, a program run by the federal government:
- Medicaid and Dr. Dynasaur.
Did anyone in your household lose health coverage from a plan with minimum essential coverage? If it happened in the last 60 days, you may get a Special Enrollment Period. You can apply up to 60 days BEFORE or AFTER the coverage ends. Did you lose the coverage because of domestic violence: Call Customer Support at 1-855-899-9600 and the apply within 60 days of the call.
You can choose when your new coverage starts based on the following rules:
(1) If you choose your new plan before the old one ends - the new plan starts the 1st day of the month after your old plan ends.
Example 1 (Reported in Advance): Health Insurance Loss – March 31
60 Day Advance Sign Up Period: Jan 30 – March 30
Special Enrollment Period: Jan 30 – May 29
Plan Confirmation: March 31
Plan Effective Date: April 1
(2) If you choose your new plan within 60 days after the old plan ended - the new plan starts the 1st day of the month after your old plan ended.
Example 2 (Default): Health Insurance Loss – March 31
60 Day Advance Sign Up Period: Jan 30 – March 30
Special Enrollment Period: Jan 30 – May 29
Plan Confirmation: April 30
Plan Effective Date: April 1
(3) If you choose your new plan within 60 days after your old plan ended and ask to start the new plan later - the plan will start the 1st day of the month after your new plan is confirmed.
Example 3 (Delayed Option): Health Insurance Loss – March 31
60 Day Advance Sign Up Period: Jan 30 – March 30
Special Enrollment Period: Jan 30 – May 29
Plan Confirmation: April 20
Plan Effective Date: May 1
Change in Household Members
Your household is you, your spouse if you're married, and your tax dependents. Household income counts the income of all household members, even those who don't need insurance. Changes in household size can change what financial help you can get.
Change in Income
If you have a Marketplace plan and your income changes, report it right away (you must update your application as soon as information changes). You may get a Special Enrollment Period when you can change your plan. What kind and how much financial help you can get may also change
Move to Vermont
Some people newly moving to Vermont may qualify for a Special Enrollment Period. Look at the 60 days before the person moved to Vermont. They or their spouse must have had insurance coverage for at least 1 day during that time. Did they live in a foreign country or a country that doesn't offer Qualified Health Plans? They may still qualify.
Hardship Exemption
A hardship exemption is necessary for people aged 30 and older to purchase catastrophic health plan coverage on the marketplace. To do this, they must meet the rules for a hardship exemption. To find out more or apply, go to Healthcare.gov for more details.
| Life Event | Additional Information & Coverage Start Date | ||
| Hardship Exemption Approved | Call 1-855-899-9600 within 60 days from date of federal exemption number being granted. Coverage Start Date: Must confirm plan by the 15th of the month to have coverage the 1st of the next month. Applicants who confirm a plan from the 16th to the last day of the month get coverage starting on the first of the second following month. Examples: Hardship Exemption Approved: May 5 Special Enrollment Period: May 5 – July 3 Plan Confirmation: May 10 Plan Effective Date: June 1 |
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| Special Enrollment Period (SEP) granted for individual to purchase a Catastrophic plan | |||
Change in Legal Status
If your citizenship status changes or your incarceration status changes, please see below.
| Life Event | Additional Information & Coverage Start Date | ||
Gaining: • U.S. citizenship • Immigration status • Lawful presence status |
New to VHC: Apply within 60 days from change in legal status. Previously on a VHC account: Call 1-855-899-9600 within 60 days Coverage Start Date: • Must confirm plan by the 15th of the month to have coverage the 1st of the next month. Applicants who confirm a plan from the 16th to the last day of the month get coverage starting on the first of the second following month. Examples: Gain Citizenship: April 27 Special Enrollment Period: April 27 – June 25 Plan Confirmation: May 7 Plan Effective Date: June 1 Gain Citizenship: April 27 Special Enrollment Period: April 27 – June 25 Plan Confirmation: May 17 Plan Effective Date: July 1 |
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| Release from incarceration (loss of Department of Corrections health coverage) | New to VHC: May apply up to 60 days prior to release from incarceration, or within 60 days from date of release from incarceration. Coverage Start Date: • First day of the month after the effective date of the household member’s release from incarceration if plan confirmation is completed before that date. OR • Must confirm plan by the 15th of the month to have coverage the 1st of the next month. Applicants who select a plan from the 16th to the last day of the month receive coverage on the first of the second following month. Examples: Release from Incarceration: April 8 60 Day Advance Sign Up Period: Feb 7 – April 7 Special Enrollment Period: Feb 7 – June 6 Plan Confirmation: Feb 10 Plan Effective Date: May 1 Release from Incarceration: April 8 60 Day Advance Sign Up Period: Feb 7 – April 7 Special Enrollment Period: Feb 7 – June 6 Plan Confirmation: May 19 Plan Effective Date: July 1 |
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| Note: All household members get a Special Enrollment Period (SEP) to add the individual released from incarceration. | |||
American Indian / Alaskan Natives
This includes members of federally recognized tribes and Alaksa Native Claim Settlement Act (ANCSA) shareholders. They can sign up any time and can change plans up to once a month. Some benefits are available to members of federally recognized tribes and ANCSA shareholders.
Ineligible for Medicaid
A qualified individual or a dependent applied for coverage during Open Enrollment or during a Special Enrollment Period and were found potentially eligible for Medicaid. After the enrollment period ended, they were found not eligible for Medicaid.
Health Reimbursement Arrangements (HRAs)
Employers with less than 50 full-time employees may offer a Qualified Small Employer HRA (QSEHRA). Employers of any size may offer an Individual Coverage HRA (ICHRA). They are both offered by employers to pay back employees back for the medical care expenses and premiums.
There are different steps for each type of offer when determining eligibility for and applying APTC. Please contact Customer Support at 1-855-899-9600 for more information.
Events that do not grant Special Enrollment Periods
The following events are commonly cited but do not grant a Special Enrollment Period:
- Loss of coverage for not paying premiums, voluntary termination of a student health plan or VIPER or COBRA.
- Except when employer contributions or government subsidies for COBRA completely stop. See Loss of affordable employer-sponsored health insurance above.
- Loss of coverage due to missing employer-sponsored open enrollment periods.
- Move to Vermont. Minimum essential coverage needs to be established prior to moving.