Qualifying Life Events

You got married, and at least one person already had health insurance.

• You have 60 days after the date of your marriage to apply for or update your health plan. 

• Your coverage will be effective as of the 1st of the month following your plan selection.

• For proof of marriage, you’ll need
  • Marriage certificate showing name and date of marriage.

• For proof of coverage within the 60 days prior to the marriage, you’ll need ONE of the following:
  • Documentation of premiums paid or invoice within 60 days of the date of marriage
  • HIPAA certification showing coverage within 60 days of the date of marriage
  • Pay stub documenting employer/insurance deduction within 60 days of the date of marriage
  • Coverage closure or termination letter showing the last date of coverage within 60 days of the date marriage
  • Other documentation showing that there was coverage within 60 days of the date of marriage

You or a dependent is pregnant, confirmed by a licensed provider.

• You have 60 days after the date the pregnancy is confirmed to apply for or update your health plan. 
• If the household is adding an unenrolled pregnant individual to existing coverage or selecting a new plan, coverage will be effective either the 1st of the month when the pregnancy was confirmed or the 1st of the month after when the pregnancy was confirmed. If the pregnant individual has existing marketplace coverage and is adding new household members or changings plans, coverage will be effective the 1st of the month after plan selection. 
• This special enrollment period does not require additional documentation.

A child is born or adopted.

• You have 60 days after the birth or adoption to apply for or update your health plan. 

• Coverage will be effective either the 1st of the month of the adoption or birth or the 1st of the month following plan selection..

• For proof of the birth or adoption, you’ll need ONE of the following:

  • Birth certificate showing the child’s name and date of birth. 

  • Court order defining the adoption or placement for adoption.

• You have 60 days after gaining a dependent through foster care, child support, or other court order to apply for or update your health plan. 

• Coverage will be effective either the 1st of the month that you gained a dependent or the 1st of the month following plan selection. 

• For proof that you gained a dependent, you’ll need ONE of the following:
  • Court order for the foster care placement
  • Court order defining the adoption or placement for adoption.

You are a member of a federally recognized American Indian or Alaska Native tribe and don’t already have health insurance.

• Coverage will be effective the 1st of the month following plan selection.

• Enrollment is open year-round and does not require additional documentation.

•  Customers can enroll or make changes only once a month. 

You become a U.S. citizen, national, or gained lawful presence.

• You have 60 days from the date of your new citizenship or immigration status to enroll in coverage or update your health plan.

• Coverage will be effective the 1st of the month following plan selection.

• For proof of citizenship/immigration status, you’ll need:

  • A document showing the new citizenship or lawfully present status with the name, status and date.

You or a family member is released from jail or prison and can now apply for your own plan or join a household plan.

• You have 60 days from your release date to enroll in coverage or update your health plan.

• Coverage will be effective the 1st of the month following plan selection.

• For proof of release, you’ll need:

• You have 60 days from your release date to enroll in coverage or update your health plan.

• Coverage will be effective the 1st of the month following plan selection.

• For proof of release, you’ll need:
  • Court order or release documents showing your name and release date. 

You or a dependent becomes newly eligible for financial help because of changes to their employer sponsored plan

• You may report changes to your employer sponsored plan and enroll in a new plan up to 60 days before or 60 days after the date that the change takes effect.

•  Qualifying changes to employer sponsored plans include
  • Employer plan benefits or cost-sharing are reduced
  • Termination of employer contributions to health coverage
  • Cost of coverage is no longer considered affordable

• If you shop for and enroll in coverage before the change to your employer plan goes into effect, your new plan will be effective as of the 1st of the month following when the change goes into effect. If you shop for and enroll in coverage after the change to your employer sponsored plan go into effect, your plan will be effective as of the 1st of the month following your plan selection.  

• For proof of changes to your employer sponsored plan, you’ll need: 
  • A letter from your employer that confirms that the employer changed or will change coverage or benefits, and that the employee’s coverage will no longer be considered qualifying health coverage.

Your household income went down, and you became eligible for financial help (not currently enrolled through Get Covered Illinois).

• You have 60 days from the decrease in your income which made you eligible for financial help to apply for coverage. To qualify you must have had other health care coverage for one or more days during the 60 days before the loss in income.
• Coverage will be effective the 1st of the month following plan selection.
• For proof that your income went down, you’ll need at least ONE of the following:
  • Employer notice showing the date the rate of pay was decreased.
  • Pay stubs that show a decrease in the hourly wage amount or hours worked between a previous pay stub and the most recent pay stub.
  • GCI will work with individuals who are self-employed to identify the documents needed to verify the income decrease. 
  • Self-employment documentation showing an income decrease.
• For proof of coverage within the 60 days prior to the decrease in income, you’ll need at least ONE of the following:
  •  

• Coverage closure or termination letter showing the last date of coverage within 60 days of the event date

  • Documentation of premiums paid or invoice within 60 days of the event date

  • HIPAA certification showing coverage within 60 days of the event date

  • Pay stub documenting employer/insurance deduction within 60 days of the  event date 

  • Other documentation showing that the last date of coverage was within 60 days of the event date

Your financial help changed (i.e., you are an existing customer and were getting help before, and now you aren’t).

• You have 60 days from the date of your eligibility determination that resulted in a change to your financial help to update your coverage. 

• Coverage will be effective the 1st of the month following plan selection.

• This special enrollment period does not require additional documentation.

You have a new Health Reimbursement Arrangement (HRA) offer from your employer (Individual Coverage HRA or Qualified Small Employer HRA).

You may report your new ICHRA or QSEHRA offer up to 60 days before or 60 days the first day that the offer would go into effect.

• If you shop for and enroll in coverage before the 1st day that your new ICHRA or QSEHRA offer could go into effect, your plan will be effective as of the 1st of the month following when your new offer could go into effect. If you shop for and enroll in coverage after the 1st day that your new ICHRA or QSEHRA offer could go into effect, your plan will be effective as of the 1st of the month following your plan selection.  

• For proof of your new ICHRA or QSEHRA offer, you’ll need:
  • Copy of the written notice from the employer explaining the terms of the HRA offered which includes employee name, the HRA type, and the start date of the benefit.

Situations that apply:

• Situations that apply:

  • You were enrolled in the wrong plan or couldn’t enroll in a plan due to an error by Get Covered Illinois or a marketplace partner.

  • You were unable to enroll in coverage during either an open enrollment period or a special enrollment period due to being assessed as potentially eligible for Medicaid/All Kids but were then redetermined as eligible for a marketplace plan. 

  • Your health insurance company broke important rules in your plan.

  • You experienced an exceptional circumstance such as a serious medical condition or a natural disaster which prevented you from enrolling in a coverage during open enrollment.

• If you think that any of these situations could apply to you, you can report your Qualifying Life Event on your Get Covered Illinois account or contact the Customer Assistance Center at +1 (866) 311-1119 (TTY: 711) for assistance.