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Congratulations on your marriage! Please submit a copy of the marriage certificate with the seal or documentation showing the marriage certificate was filed in court and proof of coverage in the last 60 days for either spouse.
A divorce or legal separation provides both parties the opportunity to begin coverage. Please submit a copy of the Dissolution of Marriage, with the judge’s/commissioner’s signature and documentation showing loss of coverage.
Death of Contract Holder
When a dependent loses coverage due to the death of the contract holder that dependent is able to begin new coverage. Please submit a Certificate of Credible Coverage, plus a copy of the obituary or a copy of the death certificate.
Birth, Adoption or Placement for Adoption
Having a baby, adopting a child or placement of a child in the adoption process qualifies the new dependent(s) and the parents to begin coverage. For a birth, please submit an application that provides the date of birth. For an adoption or placement of adoption, please submit the adoption documentation showing date of adoption or date of placement for adoption.
Dependent Turns Age 26
When a dependent covered on a parent’s plan turns age 26 they will be eligible to begin new coverage under their own plan. Please submit the Certificate of Credible Coverage showing the terminating dependent or a letter from current carrier stating the dependent’s coverage will cease due to turning age 26 or a completed Employer Documentation form.
Dependent Child(ren) Loss of Coverage
A child can enroll onto a child-only health plan if a parent/guardian voluntarily disenrolls them from the parent’s group health plan during the group’s Open Enrollment period. Please submit a signed letter, on company letterhead, from your employer stating Open Enrollment periods, names of terming dependents and last date of coverage or a completed Employer Documentation form.
Dependent Child(ren) Rejected from MO Healthnet (Medicaid)
A rejection letter will arrive after Medicaid determines that the applicant(s) does not qualify for the program. Please submit the letter from the Missouri Department of Social Services or from the Missouri Family Support Division that states rejection from MO Healthnet with dependent child(ren) name(s). Rejection for failure to cooperate or provide requested information is not a Qualifying Event.
Exceeds Maximum/ Income Allowance for/MO Healthnet (Medicaid)
This occurs when an individual or family’s income increases to the amount surpassing the Medicaid income level qualifications. Please submit the letter from Medicaid indicating that the individual exceeds the maximum income allowance. Any other reason for denial of Medicaid services is not a Qualifying Event.
Court Order, Legal Guardianship or Medical Support
Court ordered coverage can come from a judge or through the Division of Family Services. Please submit the court document signed by the Judge/Commissioner requiring medical support or granting legal guardianship. You can also send the letter from the Division of Family Services.
If your current plan ended when you moved, you have a Qualifying Event. Please submit documentation from your prior carrier stating coverage termination due to moving outside of their network area, along with your utility bill from your prior address and proof of residence within our 21-county Individual sales area.*
Loss of Minimum Essential Coverage
This happens when coverage is moved to an Affordable Care Act plan at renewal or is no longer offered. This does not include failure on your part to pay premiums or voluntary termination. Please submit the letter documenting Loss of Minimum Essential Coverage, loss of coverage date and all affected dependents.
Exhaustion of COBRA
Once COBRA runs out, you can apply for health insurance coverage as a Qualifying Event. Please submit the letter that states when you went on COBRA and date when your benefits were terminated and all affected dependents.
Termination of Employment
This applies to you resigning from your position or being terminated from an employer. Please submit a signed letter, on company letterhead, from your previous employer stating date of termination, last date of group insurance coverage, names of all covered dependents, employer contact name, title, and contact information or a completed Employer Documentation form.
Status Change/Reduction of Hours
This occurs when an employee is moving from full-time to a part-time or PRN status and is no longer eligible for group coverage. Please submit a signed letter, on company letterhead, from your employer stating date of status change/reduction of hours and if you are no longer eligible for coverage or a completed Employer documentation form.
New Employer Guideline—No Dependent Coverage
If an employer decides to stop offering group coverage to the dependents of the employees, the currently covered dependents have a Qualifying Event. Please submit a signed letter, on company letterhead, from your employer stating new guidelines, names of affected dependents and last date of coverage.
Employer No Longer Offers Group Coverage
If an employer decides to stop offering group coverage the currently covered employees and dependents can obtain coverage. Please submit a copy of the letter sent to the group prior carrier requesting termination of the group coverage, date of termination, signed by the administratior/owner on company letterhead and a copy of the prior carrier last billing statement.
*In the case of an individual gaining access to new health plans as a result of a permanent move coverage is effective:
- the first day of the following month if the application is received between the 1st and the 15th day of the month
- the first day of the 2nd month if the application is received between the 16th and the last day of the month