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.
Open Enrollment
Loss of Coverage
Change in Household Members
Change in Income
Move to Vermont
Hardship Exemption
Change in Legal Status
American Indian / Alaskan Natives
Ineligible for Medicaid
Health Reimbursement Agreements
Events that do not grant SEPs
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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.
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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:
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
| Life Event |
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Plan Type & Enrollment Information |
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Loss of affordable employer-sponsored health insurance (ESI) that provided Minimum Essential Coverage (MEC) |
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• Job loss or job change |
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• Expiration of COBRA or VIPER |
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• Employer assistance or government subsidies for COBRA ceases entirely |
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• Employer dropped coverage |
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• Expiration of hardhip exemption |
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• ESI becomes unaffordable or stops providing MEC |
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Loss of government-sponsored health plan |
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• Medicaid or Dr. Dynasaur |
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• VA benefits or TRICARE |
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• Peace Corps |
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Loss of a student health plan that provided Minimum Essential Coverage (MEC), due to: |
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• Graduation |
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• Transferring to another college |
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• Leaving school prior to graduation |
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Contact the college if you aren’t sure if the plan provided MEC or not |
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Dependent child ages off parent’s policy |
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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. |
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Child ages out of foster care (Age 18 or 19, depending on program) |
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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. |
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Loss of Minimum Essential Coverage (MEC) due to divorce, annulment, dissolution of civil union or being a victim of domestic violence |
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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. |
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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 |
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Additional Information & Coverage Start Date |
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Marriage |
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Apply within 60 days from date of marriage.
Coverage Start Date: First of the month following plan confirmation
Example:
Date of Marriage: April 10
Special Enrollment Period: April 10 – June 8
Plan Confirmation: May 20
Plan Effective Date: June 1 |
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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. |
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Household member becomes pregnant |
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Coverage Start Date: First of the month following plan confirmation
Example:
Pregnancy reported: April 23
Special Enrollment Period: Pregnancy reporting date up to date of birth.
Plan confirmation: April 27
Plan Effective date: May 1 |
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Requirements for SEP: |
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· New enrollees only (existing enrollees may not change plans). |
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· Pregnant person must attest to pregnancy and enroll in coverage. |
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· Qualifying household members (i.e., spouse and other children) may also enroll. |
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Birth or adoption |
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Apply within 60 days from date of birth/adoption.
Coverage Start Date:
• Retroactive to date of birth or adoption; billing is pro-rated.
OR
• Must confirm plan by the 15th of the month to have coverage by the 1st of the next month. Applicants who confirm from the 16th to the last day of the month get coverage starting on the first day of the second following month.
Examples:
Child Born: April 4
Special Enrollment Period: April 4 – June 2
Plan Confirmation: April 5
Plan Effective Date: April 4
Premium Effective Date: June 3
OR
Child Born: April 4
Special Enrollment Period: April 4 – June 2
Plan Confirmation: May 5
Plan Effective Date: June 1 |
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Note: Vermont 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*** |
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Adoption – through foster care program |
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No action needed - Child remains enrolled in public health plan. |
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Gaining a dependent or becoming a dependent through a child support order or other court order |
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Apply within 60 days from date of court order.
Coverage Start Date: The court ordered effective date
Example:
Court Order Issued: April 10
Court Ordered Coverage Date: May 2
Special Enrollment Period: May 2 –June 30
Plan Confirmation: May 4 Plan Effective Date: May 2 |
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Losing a household member through divorce, legal separation, or death |
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Apply within 60 days from date of divorce, legal separation, or death.
Coverage Start Date: First of the month following plan confirmation
Example:
Qualifying Event: June 4
Special Enrollment Period: June 4 –August 2
Plan Confirmation: June 5
Plan Effective Date: June 5 |
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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
| Life Event |
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Additional Information & Coverage Start Date |
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Change in income for currently enrolled customers If change in income results in: |
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Note: Must be an enrolled customer to qualify
Coverage Start Date: Must confirm plan by the 15th of the month to have coverage by the 1st of the next month. Applicants who confirm from the 16th to the last day of the month get coverage starting on the first day of the second following month.
Examples:
Income Change Occurs: May 5
Special Enrollment Period: May 5 – July 3
Plan Confirmation: May 5 Plan
Effective Date: June 1
Income Change Occurs: May 5
Special Enrollment Period: May 5 – July 3
Plan Confirmation: June 22
Plan Effective Date: August 1 |
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· Newly eligible for Advanced Premium Tax Credits (APTC): qualifies for a Special Enrollment Period (SEP) |
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· Newly ineligible for APTC: qualifies for a Special Enrollment Period (SEP) |
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· Change in cost-sharing reduction (CSR) tier |
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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.
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Life Event |
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Additional Information and Coverage Start Dates |
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Move to Vermont |
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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:
First day of the month after the effective date of the household member’s move to Vermont, if the plan conformation is completed before the date of move to Vermont.
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:
Permanent Move: 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
Permanent Move: 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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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 |
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Additional Information & Coverage Start Date |
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Hardship Exemption Approved |
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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 |
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Change in Legal Status
If your citizenship status changes or your incarceration status changes, please see below.
| Life Event |
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Additional Information & Coverage Start Date |
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Gaining:
• U.S. citizenship
• Immigration status
• Lawful presence status |
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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) |
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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. |
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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 |
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Additional Information & Coverage Start Date |
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American Indians and Alaska Natives |
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New to VHC: Apply anytime. Indian Status (federally recognized tribe) allows enrollment anytime – 1 time per month.
Coverage Start Date:
Must confirm plan by the 15th of the month to have coverage the 1st of the next month. Applicants who complete plan confirmation from the 16th to the last day of the month receive coverage beginning on the first day of the second following month.
Examples:
Special Enrollment Period: Unlimited
Plan Confirmation: June 11
Plan Effective Date: July 1
Special Enrollment Period: Unlimited
Plan Confirmation: June 21 Plan
Effective Date: August 1 |
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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.
| Life Event |
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Additional Information and Coverage Start Date |
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Being found ineligible for Medicaid |
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The individual must have been eligible for a 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:
Determined Ineligible for Medicaid: June 4
Special Enrollment Period: June 4 – August 2
Plan Confirmation: June 5
Plan Effective Date: July 1 |
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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.
| Life Event |
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Additional Information & Coverage Start Date |
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Newly eligible for HRA or QSEHRA |
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New to VHC: May apply up to 60 days prior to gaining access to an HRA/QSEHRA, or within 60 days from the date they gained access to an HRA/QSEHRA.
Coverage Start Date:
• First day of the month after the HRA/QSEHRA coverage begins if plan confirmation is completed before that date.
OR
• On the start date of HRA/QSEHRA coverage, if HRA/QSEHRA coverage begins the first day of the month, and if the plan confirmation is completed before that date.
OR
• If the enrollment is made on or after the HRA/QSEHRA coverage begins, first of the month following plan confirmation
Examples:
HRA/QSEHRA Coverage start date: 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
HRA/QSEHRA Coverage start date: April 1
60 Day Advance Sign Up Period: Feb 7 – April 7
Special Enrollment Period: Feb 7 – June 6
Plan Confirmation: Feb 10
Plan Effective Date: April 1
HRA/QSEHRA Coverage start date: June 4
Special Enrollment Period: June 4 – August 2
Plan Confirmation: June 5
Plan Effective Date: July 1 |
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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. |
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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.
- Loss of coverage due to missing employer-sponsored open enrollment periods.
- Move to Vermont. Minimum essential coverage needs to be established prior to moving.
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