Regulation .13 Special Enrollment Periods — Change in Family Status Through the Individual Exchange.
Regulation .13 Special Enrollment Periods — Change in Family Status Through the Individual Exchange.LinkCopy Citation
A.
A qualified individual, an enrollee, a qualified individual’s dependent, and an enrollee’s dependent are eligible for a special enrollment period for change in family status if the qualified individual or enrollee gains a dependent or becomes a dependent through:
(1)
Marriage;
(2)
Birth;
(3)
Adoption;
(4)
Placement for adoption;
(5)
Placement in foster care;
(6)
A child support order; or
(7)
Other court order.
B.
An enrollee is eligible for a special enrollment period for change in family status if the enrollee loses a dependent or is no longer considered a dependent through:
(1)
Divorce;
(2)
Legal separation; or
(3)
Death.
C.
Family status changes shall be determined in accordance with the law of the state where the change in family status occurred.
D.
If eligible for a special enrollment period under this regulation, a qualified individual, an enrollee, a qualified individual’s dependent or an enrollee’s dependent shall select a QHP within 60 days of the change in family status under §§A and B of this regulation.
E.
Enrollment in a QHP selected by a qualified individual, an enrollee, the qualified individual’s dependent, or the enrollee’s dependent during a special enrollment period under this regulation shall be effective:
(1)
For marriages, the first day of the month following the date that the Individual Exchange receives the QHP selection;
(2)
For birth, adoption, placement for adoption, placement in foster care, or court order, on a date chosen by the qualified individual or enrollee that is either:
(a)
The date of birth, adoption, placement for adoption, placement in foster care, or effective date of court order; or
(b)
The first day of the month following the date that the Individual Exchange receives the QHP selection;
(3)
In the case of death, the first day of the month following the date that the Individual Exchange receives the QHP selection; and
(4)
For divorces or legal separation:
(a)
Before January 1, 2025:
(i)
The first date of the following month for QHP selections received by the Individual Exchange between the first and the 15th day of the month; or
(ii)
The first day of the next following month for QHP selections received by the Individual Exchange between the 16th and the last day of a month; or
(b)
On or after January 1, 2025, the first day of the month following the date that the Individual Exchange receives the QHP selection.