Applying for Special Enrollment Health Coverage 

When your clients apply for ACA Health Insurance coverage and qualify for a Special Enrollment Period due to a life event, you may be asked to send documents to confirm that they qualify. These documents must be submitted before coverage begins.

How do I know if I need to submit additional documents? 

  • You’ll find out if you have to provide documents after you submit an application. Details and instructions will be on the client’s Eligibility Notice.
  • It’s best to pick a plan first and submit your documents afterwards. After you pick a plan, you have 30 days to send the documents.
  • Coverage start date is based on when you pick a plan. But coverage does not begin until the first premium payment is received by the insurer.
  • If your eligibility notice doesn’t say you need to submit documents, you don’t have to. Simply pick a plan and enroll.

What if the client lost or will lose health coverage soon? 

If the client already lost insurance coverage you must:

  • Pick a plan within 60 days after date coverage ended.
  • Submit documents within 30 days of picking a plan.

Coverage will start the first day of the month after you pick a plan.

If the client anticipates losing coverage in the future you must:

  • Pick a plan within 60 days before the date your coverage will end.
  • Submit documents within 30 days of picking a plan.

Coverage will start the first day of the month after existing coverage ends.

How do I submit documents?

Send the required documents as soon as possible after you pick a plan to prevent a delay in the start of coverage. Get a full list of acceptable documents to confirm loss of coverage.

Upload Documents Online

  • This is the fastest way to submit your documents.
  • You’ll need to have scanned copies or clear photos of the documents.
  • Documents must meet these requirements:
    • Accepted formats: .pdf, .jpeg, .jpg, .gif, .xml, .png, .tiff, .bmp
    • Maximum file size: 10MB
    • File names can’t include special characters like / \ : * ? “ < > |
  • Once you have the documents on your computer, log into to upload the documents.

After you submit your documents

The client should get a letter in within a couple of weeks telling you if the Special Enrollment Period is confirmed.

If the Special Enrollment Period is confirmed:

  • We’ll tell the insurance plan you picked.
  • You’ll need to pay the first premium directly to the insurance company. Insurance coverage won’t start until the first premium is paid.

If confirmation delays kept you from using your plan after the coverage start date, you may have to pay premiums for one or more previous months. When you do, medical expenses you had after the start date may be covered. This is called “retroactive” coverage.

If your Special Enrollment Period can’t be confirmed:

  • You’ll get a letter in your account explaining why.
  • You can upload different documents to confirm.

If you don’t have any of the acceptable documents, you can send a letter explaining why.  Learn more about what to include in the statement.

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