Special enrollment and qualifying events

Open enrollment for 2016 individual and family plan coverage ended Jan. 31, 2016; however, you can apply for and get health insurance coverage during the special enrollment period if you experience certain life events. See the table below for a list of the qualifying events.

To be eligible for special enrollment, you must complete your application for coverage within 60 days of the qualifying event or loss of coverage, whichever is later. If your application is not completed within this time period, it will expire and you will no longer be eligible for special enrollment.

Please note: Our acceptance of premium is not a guarantee of coverage. Providence Health Plan can request proof of your qualifying event. If you enroll under special enrollment and we later discover you cannot prove the qualifying event, Providence Health Plan can void your coverage.


Questions? Please call the Providence Health Plan sales team at 503-574-5000 or 800-988-0088, 8 a.m. to 8 p.m., Monday through Friday.

Qualifying Event Date of Event
Acquired legal guardianship Date of placement
Adoption, including placement for adoption Date of adoption
Birth Baby's date of birth
Qualified Medical Child Support Order (QMCSO) Date of issuance of court order
Death of primary enrollee causing loss of coverage Last day of coverage with other insurance
Divorce or legal separation causing loss of coverage Date of divorce or separation decree
Eligible for state premium assistance under a Medicaid or CHIP program First eligibility date
Exceed lifetime limit on medical plan Last day of coverage with other insurance
Loss of coverage except for failure to pay the premium Last day of coverage with other insurance
Marriage or Registered Domestic Partnership Date of Marriage
No longer considered a dependent Date dependent turned 26 years or date legally no longer a dependent
No longer residing or working in the service area Date began full time residency in Oregon
Plan no longer offered Last day of coverage with other insurance

Application and effective dates are as follows:

Applications received between the 1st and the 15th of the month will be given a 1st of the following month effective date if payment is received by the 1st business day of the effective month.

Applications received between the 16th and the last day of the month will be given a 15th of the following month effective date if payment is received by the 15th or the next business day of the effective month.  

For example, if the application is received April 9th, the effective date is May 1. If the application is received  April 18th, the effective date is May 15.

Open enrollment for 2017 plans is Nov. 1, 2016 through Jan. 31, 2017.