An individual can experience a qualifying life event (QLE) that makes them eligible for a plan outside the Open Enrollment Period. If you have experienced a qualifying event, you can apply for coverage within 60 days following the event, except in the case of pregnancy, you must apply within 30 days of commencement of pregnancy.
Search
Popular Tasks
Visit a ConnectiCare Center
Qualifying Life Event Descriptions
| Qualifying Event | Description |
|---|---|
| Loss of Minimal Essential Coverage (MEC) | An individual and/or any dependents lose MEC not resulting from failure to pay a premium, providing false information on a previous application, or voluntarily ending prior MEC.
|
| Loss of employer group coverage | |
|
The termination or reduction of hours of a covered employee’s employment that results in loss of group health coverage |
|
A dependent loses coverage because of the death of a covered employee under a group plan |
|
A covered dependent loses group health coverage because of a covered employee’s eligibility for Medicare |
|
|
Gained or became a dependent
|
Marriage: One of the individuals must demonstrate that they had MEC for one or more days during the 60 days preceding the date of marriage, or that they lived in a foreign country or U.S. territory. |
Other Reasons
|
Divorce or legal separation: The divorce or legal separation that results in a loss of group health coverage End of Dependent Status: A dependent child loses coverage due to loss of dependent status under an employee’s group health plan Change in eligibility for advanced premium tax credits or cost sharing reductions: Eligibility for advanced premium tax credits or cost sharing reductions changed Moved into ConnectiCare Service Area: New coverage becomes available to an individual or enrollee who has permanently moved into the ConnectiCare service area, and the individual had MEC for one or more days preceding the date of the permanent move, unless moving to the U.S. from a foreign country or U.S. territory Released from Incarceration: Incarcerated means serving a term in prison or jail. An individual is not considered incarcerated if he is in prison or jail pending disposition of charges – that is, being held but not convicted of a crime. HHS interprets release from incarceration as a permanent move that qualifies an individual for a new plan they previously could not access. Error in enrollment: An individual experiences an error in enrollment Plan or other carrier violated a material provision of an enrollment contract: An individual adequately demonstrates that the plan or other carrier substantially violated an important provision of the contract in which he or she is enrolled Pregnancy not more than 30 days after its commencement as certified by a licensed health care provider: Written certification must be provided by a licensed healthcare provider acting within the scope of such health care provider’s practice not more than 30 days after the commencement of the pregnancy. This is limited to individuals who meet the above criteria who do not have, at a minimum, alternate coverage with essential health benefits or coverage requirements under Connecticut’s Health Insurance law. |
