Special enrollment and qualifying events

Open enrollment for 2020 individual and family plan coverage ended December 15, 2019; 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.

Oregon policyholders may obtain coverage due to a special enrollment qualifying event by submitting an application for coverage to either Providence Health Plan or the Healthcare.gov Marketplace within 60 days of the qualifying event.

Washington policyholders may obtain coverage due to a special enrollment qualifying event by submitting an application for coverage to WaHealthPlanFinder.gov 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? For Oregon Marketplace questions, contact the Healthcare.gov call center at 1-800-318-2596. For Washington Health Plan Finder questions, call 1-855-923-4633.

Qualifying events:

  • Involuntary loss of individual or group coverage except for failure to pay the premium
  • Marriage or domestic partnership*
  • Birth, adoption, placement for adoption or foster care of a child
  • Qualified Medical Child Support Order (QMCSO)
  • Acquisition of legal guardianship
  • Permanent move to a new PHP service area that offers different health plan options
  • Loss of coverage as a dependent due to age
  • Loss of coverage due to end of marriage or domestic partnership*
  • Involuntary loss of Medicaid or CHIP coverage
  • Newly eligible for a state- or federal- sponsored premium assistance program
  • Loss of Advance Premium Tax Credit (APTC) or Cost Sharing Reductions (CSR)
  • Survivor of domestic abuse/violence or spousal abandonment and wants to enroll in a health plan separate from the abuser or abandoner
  • Denial of Medicaid or CHIP eligibility determined after open enrollment ended or more than 60 days after a qualifying event

*Oregon: A Domestic Partner must be a member of the Policyholder’s same sex, 18 years of age or older, and must have legally registered a Declaration of Domestic Partnership and obtained a Certificate of Registered Domestic Partnership in accordance with Oregon state law.

*Washington: A Domestic Partner must be at least 18 years of age. They must be a member of the Policyholder’s same sex, unless one of the partners is at least 62 years of age, and they must have legally entered into a State Registered Domestic Partnership and obtained a Certificate of State Registered Domestic Partnership in accordance with Washington state law.

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 or WaHealthPlanFinder, 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.