Special enrollment

You must qualify for special enrollment to be eligible to enroll in a medical or dental plan outside of the annual open enrollment period, and/or to have your coverage take effect sooner than it could otherwise.

If you have questions regarding this transition, please email us at individualplans@modahealth.com or call us at 855-718-1767, Monday through Friday, 7:30 a.m. to 5:30 p.m. Pacific Time. 

How to enroll

As part of the enrollment process, you will need to provide proof of the life event that makes you eligible. You have up to 60 days from your event to apply. For events related to loss of minimum essential coverage and transition from a non-calendar year group plan, you can apply 60 days before or after the event.

To enroll:

  • Download an enrollment application:
    Medical
    2017 
    2017 Oregon Beacon application For residents of Clackamas, Clatsop, Columbia, Coos, Curry, Hood River, Jackson, Josephine, Marion, Multnomah, Polk, Wasco, Washington and Yamhill counties
    2017 Oregon Affinity application For residents of Baker, Grant, Gilliam, Harney, Lake, Malheur, Morrow, Sherman, Umatilla, Union, Wallowa and Wheeler counties
    Dental
    2017 
    2017 Oregon Dental application
    For all Oregon residents
    2017 Alaska Dental application
    For all Alaska resident


  • Locate your life event on the list below and gather the required documents
  • Follow the instructions on the last page of the application to submit it along with the required documents


Life events

Qualifying event

What you need

Coverage effective date

New dependents

You have a newborn

A birth certificate (Hospital, county, or government issued only) or letter from medical center showing proof of birth

The date of birth of your newborn or the 1st of the month following birth upon request

You gained a spouse or domestic partner or you became a spouse or domestic partner (including children of spouse or domestic partner)

Your marriage certificate or Certificate of Registered Domestic Partnership

The 1st of the month following receipt of your application

You gained a dependent or became a dependent through adoption, placement for adoption or foster care

The adoption paperwork or proof of placement for adoption

or

Evidence of proof from a court or state agency that you have the legal right to make medical decisions for a child in foster care

The date of adoption or placement or the 1st of the month following adoption or placement upon request

You have a child support order or other court order

A copy of child support order or applicable court order

The date the court order is effective or 1st of the month following court order effective date upon request

Loss of minimum essential coverage

The 1st of the month following the loss of coverage if plan selection is made on or before the day of the triggering event. Otherwise dates shown below apply

You lost healthcare coverage due to termination of employment

Documentation from employer demonstrating loss of employment

The 1st of the month following receipt of your application (1st of the second following month if applying on and after the 16th)

You lost healthcare coverage due to divorce or termination of domestic partnership

Your divorce papers

or

Documentation from appropriate government entity demonstrating termination of domestic partnership

The 1st of the month following receipt of your application (1st of the second following month if applying on and after the 16th)

You or a dependent turned 26 and are no longer eligible for the current plan

Either:

A letter from employer on business letterhead confirming loss of coverage

and

A coverage cancellation notice or Certificate of Creditable Coverage

 

Or:

A copy of letter from the carrier explaining reason for dependent cancellation

The 1st of the month following receipt of your application (1st of the second following month if applying on and after the 16th)

You lost healthcare coverage due to a job-related loss of eligibility

A coverage cancellation notice or Certificate of Creditable Coverage

and

Documentation or letter from employer on business letterhead confirming loss of coverage or reduction of hours of employment to less than the number of hours required for eligibility

The 1st of the month following receipt of your application (1st of the second following month if applying on and after the 16th)

You lost healthcare coverage due to Military Discharge

A Certificate of Release or Discharge from Active Duty

Date of discharge

You lost healthcare coverage due to expiration of:

  • COBRA coverage
  • Grandfathered coverage

A coverage cancellation notice or Certificate of Creditable Coverage

The 1st of the month following receipt of your application (1st of the second following month if applying on and after the 16th)

You or your dependent lost eligibility for Medicaid or CHIP

A notification of loss of Children’s Health Insurance Program or Medicaid coverage from state program

The 1st of the month following receipt of your application (1st of the second following month if applying on and after the 16th)

 You applied and were expected to be eligible for Medicaid or CHIP, but were ultimately determined ineligible after open enrollment ended or more than 60 days after the qualifying event Documentation of from the US Department of Health and Human Services (HHS) on open enrollment application and transfer to Medicaid or CHIP for eligibility review

and 

Documentation from Medicaid or CHIP on final ineligibility determination
 The first of the month following receipt of your application (1st of the second following month if apply on and after the 16th)

You lost healthcare coverage due to QHP decertification

Documentation of QHP decertification from the US Department of Health and Human Services (HHS) or other appropriate government entity

The 1st of the month following receipt of your application (1st of the second following month if applying on and after the 16th)

You lost your individual or group coverage due to:

  • Voluntary termination of coverage
  • non-payment
  • fraud or material misrepresentation

N/A – must wait until Open Enrollment


Others

You make a permanent move to a new area that offers different health plan options if you either had minimum essential coverage at least one day during the 60 days preceding the date of the permanent move OR you were living outside of the US or US territory at the time of the permanent move

*Moving solely for medical treatment or vacation is not a qualifying event

For school-aged children (applying solo), you will need:

A school enrollment record from the former school

and

A school enrollment record for Oregon or Alaska

 

For adult applicants & families, you will need:

From both your previous and new address, at least one of the following:

  • Utility billing statement
  • Lease or rental agreement
  • Mortgage statement

 

If you are moving from another country, please submit a copy of your Visa or passport information page (with your photograph and personal details) and the date-stamped page.

The 1st of the month following receipt of your application (1st of the second following month if applying on and after the 16th) if plan selected after move.

You drop a dependent or choose to transition to individual coverage from a non-calendar year group plan during the group’s annual enrollment period

Documentation from employer demonstrating the availability of the group’s annual enrollment period

Open enrollment when you drop a dependent. When you choose to transition to individual coverage, if plan selection is made before the end of the group’s plan year, the 1st of the month following group plan renewal date. 

Otherwise, the 1st of the month following receipt of your application (1st of the second following month if applying on and after the 16th)

 

You are newly ineligible for APTC or CSR

Documentation of APTC disqualification from the US Department of Health and Human Services (HHS)

Effective 1st of month following receipt of your application (or 1st of the second following month if applying on and after the 16)

You lost healthcare coverage due to QHP enrollment or disenrollment because of a HHS error or errors made by the entity providing enrollment assistance or conducting enrollment activities

Documentation of error from the US Department of Health and Human Services (HHS)

or

Documentation of error from the entity providing enrollment assistance or conducting enrollment activities

If plan selection is made before the change in income or the move from a non-Medicaid expansion state to a different state, the 1st of the month following group plan renewal date.

Otherwise, the 1st of the month following receipt of your application (1st of the second following month if applying on and after the 16th)

A QHP in which you enrolled substantially violated a material contract provision

Documentation of QHP material violation from the US Department of Health and Human Services (HHS)

Appropriate date for the special enrollment circumstance, as determined by Moda

You are a victim or the dependent of a victim of domestic abuse or spousal abandonment

Documentation will be determined on a case-by-case basis

Effective 1st of the month following receipt of your application (or 1st of the second following month if applying on and after the 16th)