Special enrollment and qualifying events

Open enrollment for 2017 individual and family plan coverage ended Jan. 31, 2017; 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 obtain coverage due to a special enrollment qualifying event, you must submit an application for coverage to either Providence Health Plan or the Healthcare.gov Marketplace within 60 days of the qualifying event. The effective date of coverage is determined by the qualifying event as well as the receipt of the initial premium:

  • When the qualifying event is birth, adoption, or placement for adoption or foster care; coverage will be effective from date of birth, adoption, or placement for adoption or foster care, provided the initial premium is received within 60 days of birth, adoption, or placement.
  • For all other special enrollments, coverage will be effective the first day of the month per the application and effective dates table indicated below provided the initial premium is received by the first day of the effective month.

If your application is not completed within 60 days of the special enrollment qualifying event, it will expire and you will no longer be eligible for special enrollment.

Questions? Please call the Providence Health Plan sales team at 503-574-5000 or 800-988-0088, 8 a.m. to 5 p.m., Monday through Friday or your producer/agent. For Marketplace enrollees, you may also want to contact the Healthcare.gov Marketplace call center at 1-800-318-2596, available 24 hours a day, 7 days a week.

Qualifying Event Date of Event
Acquired legal guardianship Date of placement
Adoption or placement for adoption or foster care of a child
Date of adoption or placement
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
Loss of coverage due to end of marriage or domestic partnership Date of divorce or separation decree
Lose or become eligible for state premium assistance under a Medicaid or CHIP program
First or last eligibility date
Involuntary 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
Loss of coverage as a dependent due to age
Date dependent turned 26 years old or date legally no longer a dependent
No longer residing in the service area Date of relocation
Involuntary termination of COBRA coverage
Last day of COBRA coverage
Survivor of domestic abuse/violence or spousal abandonment and wants to enroll in a health plan separate from the abuser or abandoner Date of action to leave abusive situation or date of spousal abandonment

Please note: Our acceptance of premium is not a guarantee of coverage. If you are applying directly, Providence Health Plan can request proof of your qualifying event. If applying through the Marketplace, they may also request documentation. If you enroll under special enrollment and later it is discovered you cannot prove the qualifying event, your coverage may be cancelled. 

Application and effective dates are as follows:

The Effective Date of Coverage is determined by the date of your completed application as well as the date Providence Health Plan receives the initial Premium. See table below:

Date Application is Received  Coverage Effective Date  Date Initial Payment Must be Received by Providence 
Special enrollment
 1st – 15th of the month
 1st day of the following month
 1st day of the following month
16th – last day of the month  1st day of the 2nd following month  1st day of the 2nd following month 

Examples: If your application is received on March 5th, your coverage effective date is April 1st providing you have paid by this date. If your application is received on March 20th, your coverage effective date is May 1st providing you have paid by this date.

Open enrollment for 2018 plans is currently planned for Nov. 1, 2017 through Dec. 15, 2017.