Individual and Family Plans - Getting started

*Please give the reason for the change and enter the date the event happened

* Date of event

Documentation is required to confirm your eligibility due to a loss of minimum essential coverage/Group Coverage.

You will have the option of uploading the document(s) after completing the online shopping process. Should you choose instead to print your application, it must be mailed in with the necessary documentation before the enrollment can be processed. You will not be able to save or submit your application without documentation.

Some examples of appropriate documentation are:

• Certificate of Creditable Coverage from your previous insurance carrier.
• Letter from your previous employer or insurance carrier indicating the last date of coverage.
• Letter from a Government Agency, such as Medicaid or CHIP, indicating the last date of coverage.

Becoming eligible for an Advanced Premium Tax Credit (APTC) due to a decrease in your income may be used as a Special Enrollment Period to enroll in coverage through the Federally Facilitated Marketplace. Visit www.healthcare.gov to see if you qualify.

Documentation is required to confirm your eligibility due to being newly eligible for ICHRA/QSEHRA.

You will have the option of uploading the document(s) after completing the online shopping process. Should you choose instead to print your application, it must be mailed in with the necessary documentation before the enrollment can be processed. You will not be able to save or submit your application without documentation.

Some examples of appropriate documentation are:

• ICHRA Employer Notice including the dollar amount of the HRA offer, the date that coverage under the HRA may begin, and whether the offer extends to dependents.