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For Questions on a new plan, contact us at 800.926.8227
For Questions on an existing plan, contact us at 800.362.3310

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To determine your effective date, please complete the information below. Learn more about Special Enrollment Periods.
Existing members please note: Due to new regulations, you may not be able to switch the type of plan or Metal Level (i.e. from Gold to Bronze) during a special Enrollment Period (SEP).


Enrollment Reason Additional Documentation That May be Required
Birth or Adoption of Child Copy of adoption papers or copy of birth certificate.
Loss of Coverage Copy of certificate of creditable coverage or copy of termination letter from existing / prior insurance company.
Marriage (Includes civil union and / or domestic partner) Copy of signed marriage certificate, civil union certificate or domestic partner affidavit.
and proof that at least one spouse had Minimum Essential Coverage for at least 1 day within 60 days prior to marriage (see loss of coverage documentation requirements) or if moving from outside the United States a Visa to prove Marriage.
Permanent Move Consumer’s prior residential address and proof of current residential address by providing one of the following:
  • Mortgage bill / renter’s agreement with new residential address and occupancy date
  • Utility bill or phone bill
  • Postal Service change of address receipt showing old address, new address, and effective date
  • Copy of a paycheck stub
and proof member had Minimum Essential Coverage for at least 1 day within 60 days prior to moving (see loss of coverage documentation requirements) or if moving from outside the United States a Visa to prove permanent move.

Enrollment Reason: