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Coverage Enrollment Period
Whereas individuals can apply for MC at any time, they can only enroll or change APTC, CSR, Qualified Health Plan (QHP) during open enrollment, special enrollment, or renewal. If clients, who are eligible for APTC/CSR or QHP, do not choose a health plan during open enrollment, then they will have to wait until the next open enrollment to sign-up, unless special enrollment is applicable.
- If a client selects a plan between the first and 15th of the month, the coverage will start the first of the following month.
- If a client selects a plan from the 16th through the end of the month, the coverage will start the first of the second following month.
Note: There are no enrollment restrictions for MC.
Open Enrollment
Open Enrollment occurs once a year. It occurs sometime between October and February, usually November 1 through January 31. However, there may be circumstances for an individual or tax filing household that will create a Special Enrollment Period.
Special Enrollment
Special Enrollment is a period after a qualifying life event, when a client can enroll in a health plan outside of the open enrollment period. The client has 60 days from the date of a qualifying life event to enroll in a health plan or change the existing plan through Covered CA.
Note: If a client does not enroll within 60 days, he/she must wait until the next open enrollment to sign-up for APTC, CSR, or QHP.
Qualifying life events include:
- Loss of MEC
- Birth of a child
- Change in marital status
- Moving to a new Covered CA region
- Turning 26 years of age
Note: Special enrollment is not available for clients who fail to pay insurance premiums or clients who request discontinuance or cancellation of their health insurance plan; clients would need to wait until the next Open Enrollment period following non-payment related discontinuance, voluntary discontinuance, or cancellation.
APTC/CSR/QHP Renewal
All Covered CA renewals (APTC/CSR/QHP annual redetermination process), occur between mid-October through mid-December, giving clients the opportunity to renew their health plan selections. Renewals apply to all subsidized and unsubsidized households who have enrolled in a plan and have made their first premium payment.
Covered CA automatically renews clients, with the exception of clients who choose not to allow automatic renewal and those clients who had significant change in circumstance from one year to the next. If auto-renewal is not available, a manual renewal or manual verification may be required. Clients have a right to appeal renewal decisions. They should contact Covered CA for APTC/CSR or QHP appeal information.
Note: MC Redeterminations occur throughout the year and may not align with the APTC/CSR/QHP renewal period.
During the Covered CA renewal process, Covered CA clients may become eligible for MC.
Coverage Available
Covered CA health plans are insurance plans that, starting in 2014, match all the criteria specified in ACA. Covered CA health Plans must:
- Be certified by the exchange
- Provide essential health benefits
- Follow established limits on cost sharing
- Meet other requirements as set by Covered CA
- Hold certification
- Provide insurance to individuals and families with limited income who meet eligibility requirements
- Provide dental and vision coverage for children
- Provide dental coverage for adults
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