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Special Enrollment Period

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Do I Qualify for a Special Enrollment Period? 

After the Open Enrollment Period ended on December 15, you can only enroll in or make changes to your coverage if you have experienced a qualifying life event. Learn more below.

Qualifying Life Events

You may qualify to enroll through a Special Enrollment Period if one of the following applies to you.

If there was a change to your household or family structure, you may qualify for a Special Enrollment Period.

Examples include:

  • Getting married
  • Had a baby or adopted a child
  • Had a child placed for foster care
  • Getting divorced or legally separated and lost health insurance
  • Death in the family and lost health insurance as a result

If you permanently moved, you may qualify for a Special Enrollment Period.

Examples of qualified moves include:

  • Moving to a different ZIP code or county
  • Moving to the U.S. from another country
  • Student moving to or from the place they attend school

Note: In addition to moving, you also must prove you had qualifying health coverage for one or more days during the 60 days before your move.

If you or anyone in your household involuntarily lost their health coverage, you may qualify for a Special Enrollment Period.

Examples of involuntary loss of coverage include:

  • Losing employment-based health insurance
  • Losing individual health insurance
  • Losing eligibility for public insurance coverage such as Medicare, Medicaid or CHIP

Note: Voluntarily ending your health coverage or being terminated for not paying your premiums are not considered involuntary loss of coverage.

Other complicated or less common situations may also qualify you for a Special Enrollment Period.

Examples include:

  • Becoming a U.S. citizen
  • Released from prison
  • Experience a Marketplace enrollment error
  • Changes to your income that could make you eligible to enroll in a different type of coverage, either individual or a public insurance program like Medicaid or CHIP
  • Determined ineligible for Medicaid or CHIP

Your state's Health Insurance Marketplace will have a complete list.

Applying for Coverage

If you believe one of the life events above applies to you, here's what you need to know.

You can apply for coverage through your state's Health Insurance Marketplace*. Typically, you must enroll within 60 days of the events date.

There are 2 easy ways to shop and compare your options:

Shop with Medica
Get a quote and compare plans in your area using our quoting tool.

Start shopping with Medica

 

Shop your state's Health Insurance Marketplace 
Shopping your state's Health Insurance Marketplace is the only way to determine if you're able to get help paying for your health plan. You'll also be able to get a quote and compare Medica plans that are available in your area.

Start shopping on the Marketplace
For  Iowa, Kansas, Nebraska and Wisconsin residents

Start shopping on MNsure
For Minnesota residents


Not sure what to consider when choosing a plan? Learn how to be a smart shopper

*Nebraska residents also can enroll through our quoting and enrollment tool.

When you apply for coverage through a Special Enrollment Period, you may need to provide documents to confirm your life event. Your state’s Health Insurance Marketplace will let you know what documents are required with your application and your options for sending them in.

You have 30 days after you apply to send in your documents. However, you should send in your required documents as soon as possible to prevent a delay in your coverage starting. If you do not provide the required documents, your application may be withdrawn*.

*Note: We’ll refund any payments made if your application is withdrawn.

If your application is approved*, you’ll need to pay your first month premium for your coverage to activate. You can pay your premium:

On the Marketplace (HealthCare.gov) at the time of application (Not available to Minnesota residents)
This is the fastest way to ensure your first month payment is made and that your coverage will begin.

 

 

Using Medica's Payment Website 
We offer a secure payment site to make your payment electronically with your checking/savings account.

Make an online payment >

 

Mail
If you prefer, complete this form and return it with your payment (check or money order) to Medica. Make sure you mail it well in advance!

Medica
PO Box 856525
Minneapolis, MN 55485-6523 

  
*If applying through your state’s Health Insurance Marketplace, they’ll determine if you’re eligible to enroll through a Special Enrollment Period.

Here’s a quick summary of the materials you will receive from us so you can start using your benefits.

What Medica is doing:

Reviewing your application and setting up your policy.
We’ll contact you if we need more information.

Creating your ID card and welcome kit.
After you make your first month payment, you should receive these materials 7-10 days after we process your payment.

 


What you can do:

Sign up for automatic payments.
Once you have your ID card, visit medica.com/AutomaticPayments to automate your monthly premium payment and never worry about missing a payment again.

Explore Medica’s member hub.
Visit medica.com/Members to find information such as:

  • Your summary of benefits and coverage document
  • Your policy of coverage document
  • A listing of doctors, clinics, hospitals and pharmacies in your network
  • A list of drugs covered by your plan

Register for your secure member portal.
Access your personal medical and pharmacy claims 24/7, 365. Go to MedicaMember.com and follow the steps to set up your account.

Were Here to Help

There are several options for getting help.

Iowa, Kansas, Nebraska and Wisconsin Residents:
Call the Health Insurance Marketplace Call Center
1-800-318-2596 (TTY: 1-855-889-4325).
Available 24 hours a day, 7 days a week (except holidays)

Minnesota Residents:
Call MNsure’s Call Center
1-855-366-7873 (TTY: 711)
8 a.m. to 6 p.m. Central, Monday-Friday
10 a.m. to 2 p.m. Central, Saturday

If you work with a licensed agent or broker, they are your best resource for answering questions and helping you enroll in coverage.

Interested in working with an agent or broker? Find one near you.

Find an Agent >

You may work with one of our specially trained sales consultants.

Call
1-800-670-5935 (TTY: 711)
8 a.m. – 5 p.m. Central, Monday – Friday
(Closed 8 – 9 a.m. Fridays)

Email
MedicaIndividualProducts@medica.com

You may work with a certified application counselor, navigator, clinic or hospital-based financial counselor to answer your questions and help you enroll in coverage.

Iowa, Kansas, Nebraska and Wisconsin Residents:
Visit the Health Insurance Marketplace (HealthCare.gov) to find help in your area.
Find help >

Minnesota Residents:
Visit MNsure (MNsure.org) to find help in your area.
Find help >

Date: 4/21/2018 10:06:18 PM Version: 4.0.30319.42000 Machine Name: PWIVE-CMSWEB02