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.
Find a category that fits your situation to see if you qualify for a Special Enrollment Period. Each life event includes what you need to do, when you need to take action, and when new health coverage would take effect.
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?
- First of the month following plan selection.
- Example:
Plan Confirmation: August 20
Plan Effective Date: September 1
- Example:
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:
- 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
- Example 1 (Reported in Advance): Health Insurance Loss – March 31
- 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
- Example 2 (Default): Health Insurance Loss – March 31
- 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
- Example 3 (Delayed Option): Health Insurance Loss – March 31
| Life Event | Plan Types & Enrollment Information |
|---|---|
| Loss of affordable employer-sponsored health insurance (ESI) that provided Minimum Essential Coverage (MEC) |
|
| Loss of government-sponsored health plan |
|
| Loss of a student health plan that provided Minimum Essential Coverage (MEC), due to: |
|
| Dependent child ages off parent’s policy | Note: Only the dependent losing coverage gets a Special Enrollment Period (SEP); other household members do not qualify for an SEP. After turning 26, dependents can stay on a parent’s health plan through the end of the year or until the family experiences a Special Enrollment Period, whichever happens first. Permanently disabled dependents may remain on parent’s plan after age 26. |
| Child ages out of foster care (age 18 or 19, depending on program) | Note: The household gets a Special Enrollment Period (SEP) to add a dependent who aged out of foster care, if the dependent is no longer eligible for foster care health coverage by the state. |
| Loss of Minimum Essential Coverage (MEC) due to divorce, annulment, dissolution of civil union or being a victim of domestic violence | Note: Spouse losing coverage gets an SEP; spouse remaining on policy gets eligibility redetermination but does not get an SEP unless they have another life change on this list. |
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.
| Life Event | Additional Information and Coverage Start Date |
|---|---|
| Marriage
Note: Requires that applicant or spouse had health coverage or lived in a foreign country or a county that does not offer Qualified Health Plans, for at least 1 day during the 60 days prior to the marriage. |
Apply within 60 days from date of marriage. Coverage Start Date: First of the month following plan selection Example: |
| Household member becomes pregnant.
Requirements for SEP:
|
Coverage Start Date: First of the month following plan selection Example: |
| Birth or adoption
Note: VT law gives newborns 60 days of free health coverage on their parent's plan. Starting on day 61, there is a monthly premium change to include the newborn on the plan.***There is a specific process for this based on which start date the parent chooses*** |
Apply within 60 days from date of birth/adoption.
Coverage Start Date:
Examples: - OR - Child Born: April 4 |
| Adoption through foster care program | No action needed. Child remains enrolled in public health plan. |
| Gaining a dependent or becoming a dependent through a child support order or other court order | Apply within 60 days from date of court order.
Coverage Start Date: The court ordered effective date Example: |
| Losing a household member through divorce, legal separation, or death | Apply within 60 days from date of divorce, legal separation, or death.
Coverage Start Date: First of the month following plan confirmation Example: |
Change in Income
If you have a Marketplace plan or are directly enrolled 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.
| Life Event | Additional Information and Coverage Start Date |
|---|---|
|
Change in income for currently enrolled customers if change in income results in:
|
Note: Must be an enrolled customer to qualify Coverage Start Date:
Example: |
Move to Vermont
Some people newly moving to Vermont may qualify for a Special Enrollment Period. Look at the 60 days before moving to Vermont. You or your spouse must have had insurance coverage for at least 1 day during that time. Did you live in a foreign country or a country that doesn't offer Qualified Health Plans? You may still qualify.
| Life Event | Additional Information and Coverage Start Date |
|---|---|
|
Move to Vermont |
New to VHC: May apply up to 60 days prior to moving to Vermont, or within 60 days from date of permanent move. Coverage Start Date:
Examples: Permanent Move: April 8 |
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, you 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 and Coverage Start Date |
|---|---|
|
Hardship Exemption Approved Special Enrollment Period (SEP) granted for individual to purchase a Catastrophic plan |
Call 1-855-899-9600 within 60 days from date of federal exemption being granted. Coverage Start Date: First of the month following plan selection Example: |
Change in Legal Status
If your citizenship status changes or your incarceration status changes, please see below.
| Life Event | Additional Information and Coverage Start Date |
|---|---|
|
Gaining:
|
New to VHC: Apply within 60 days from becoming newly eligible for QHP Previously on a VHC account: Call 1-855-899-9600 within 60 days Coverage Start Date: First of the month following plan selection Example: |
|
Release from incarceration (loss of Department of Corrections health coverage) Note: All household members get a Special Enrollment Period (SEP) to add the individual released from incarceration. |
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:
Examples: Release from Incarceration: April 8 |
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.
| Life Event | Additional Information and Coverage Start Date |
|---|---|
|
American Indians and Alaska Natives |
New to VHC: Apply anytime. Indian Status (federally recognized tribe) allows enrollment anytime – 1 time per month Coverage Start Date: First of the month following plan selection Example: |
Ineligible for Medicaid after New Application
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.
| Life Event | Additional Information and Coverage Start Date |
|---|---|
|
Being found ineligible for Medicaid |
The individual must have been eligible for an SEP when they initially applied or applied during Open Enrollment. The individual was then found ineligible for Medicaid to qualify for this SEP. Simply being found ineligible for Medicaid does not grant this SEP. Coverage Start Date: First of the month following plan selection Example: |
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 advanced premium tax credits (APTC). Please contact Customer Support at 1-855-899-9600 for more information.
| Life Event | Additional Information and Coverage Start Date |
|---|---|
|
Newly eligible for HRA or QSEHRA: Qualified individual and their dependents newly gain access to an individual coverage HRA or QSHERA. The triggering event is the first day on which coverage for the qualified individual, enrollee, or dependent under the HRA/QSEHRA can take effect. |
New to VHC: May apply up to 60 days prior to gaining access to an HRA/QSEHRA, or within 60 days from the date customer gains access to an HRA/QSEHRA. Coverage Start Date:
Examples: HRA/QSEHRA Coverage Start Date: April 1 HRA/QSEHRA Coverage Start Date: June 4 |
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.
- Exception: 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 (MEC) needs to be established prior to moving.