Skip to main content

Important Message: Keep your account up to date! Check to make sure we have your correct address, email and phone number. We want to make sure we can stay in touch with you.

Exceptional Circumstances Special Enrollment Period

Type your first name here.
Type your last name here.
Select your date of birth.
Address:
Enter your mailing address.
Type your phone number here.
Tell us why you are asking for an Exceptional Circumstance Special Enrollment Period.
Select the date your exceptional circumstance started.
For example: if you became medically incapacitated on 2/15/2020, that is the start date. If you were released from the hospital on 3/1/2020, that is the end date.
Do you need medical care right now? For example, doctor's appointments or prescriptions?
Tell us why you need access to care right now.
  • This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.