Qualifying Events

Important Message:  2020 Open Enrollment starts November 1 and ends December 15! This is the time when any Vermonter can sign up for 2020 health coverage, or make changes to an existing plan. If you lose health coverage or have another qualifying event after Open Enrollment ends, you can still sign up but need to act fast. If you wait more than 60 days to apply and select your plan, you might have to wait until next year to get health insurance.

 

Medicaid and Dr. Dynasaur enrollment continues year round. To see if you might qualify for one of these programs, check out the Plan Comparison Tool.

Alternatively, if you've recently experienced a qualifying life event, you might qualify for a special enrollment period. 

Qualifying Events

  • Loss of coverage – employer sponsored or public plan
  • Aging out of parental coverage or foster care
  • Release from incarceration
  • Marriage/divorce/annulment
  • Household member becomes pregnant
  • Birth/adoption/placement for adoption
  • Court-ordered coverage
  • Change in legal status (citizenship, immigration eligible, lawfully present)
  • Moves permanently into the state
  • Employer-sponsored insurance unaffordable/inadequate
  • Change in income resulting in change in APTC/CSR eligibility
  • Native Americans (status allows enrollment any time)
  • Hardship exemption approved or expires

 Exceptional Circumstances

In addition to the standard list of qualifying events (above), special enrollment periods can be granted under additional exceptional circumstances.   An individual should apply for the Exceptional Circumstance Special Enrollment Period (SEP) only if an event such as a medical issue, natural disaster, or a system interruption prevented them from enrolling in a QHP during the Annual Open Enrollment or during a SEP the individual was eligible for that has now expired.  Please review the examples provided below for additional clarification.

Example #1

An individual qualified for a Special Enrollment Period that expired March 31st.  The individual was in the hospital from March 14th to April 1st and was unable to enroll in a QHP at that time.  This individual should complete this application as well as the medical incapacity verification form as they may be eligible for the Exceptional Circumstance SEP.

Example #2

An individual qualified for a Special Enrollment that expired May 31st.   The individual got sick in July after their original SEP expired and now needs health coverage.  The individual should not complete this form as they were not medically incapacitated (sick) during their original Special Enrollment Period and not prevented from enrolling prior to May 31st, therefore would not qualify for the Exceptional Circumstance SEP.

If you would like to apply for an Exceptional Circumstances Special Enrollment Period, click here. If you have a question about an exceptional circumstance, or need to change an existing application, please call 1-855-899-9600.