What Do I Need to Prove Loss of Coverage?
Documentation is required by the insurance carrier to prove the loss of qualifying health coverage when applying for health coverage during a special enrollment period (SEP).
You must submit documents that show you lost qualifying health coverage within the past 60 days or will lose it within the next 60 days. These documents must include your name and the date of coverage loss. These are the types of documents typically accepted:
1. Letter from an Insurance Company
A letter or premium bill from your former insurance company, on official letterhead or stationery, showing that you or your dependent's health coverage was canceled or terminated.
A decertification letter from your insurance company indicating when coverage will no longer be offered.
2. Letter from an Employer
A letter on official letterhead or stationery confirming one of the following for you, your spouse, or a dependent family member:
- Your employer dropped or will drop your health coverage or benefits.
- Your employer stopped or will stop contributing to your coverage.
- Your employer changed your coverage, so it is no longer considered qualifying health coverage.
3. COBRA Coverage Letter
A letter from your employer or health insurance company confirming:
- The offer of COBRA coverage and when it would begin.
- That COBRA coverage has ended or will end, or that your employer stopped or will stop contributing to your COBRA coverage.
4. Health Care Program Document
- A letter on official letterhead or stationery from a government health program (such as TRICARE, Veterans Affairs (VA), Peace Corps, or Medicare) showing when your coverage ended or will end.
- A letter from your state's Medicaid or CHIP agency showing that your eligibility was denied or that your Medicaid or CHIP coverage ended or will end.
- A dated copy of your military discharge document (DD214).
5. Letter Regarding Student Health Coverage
- A letter on official letterhead or stationery showing when your student health coverage ended or will end.
What if I Don't Have These Documents?
If you cannot provide any of these documents, you can submit a letter explaining your coverage, why and when you lost or will lose it, and why you cannot provide documentation. Use this form and complete the “Loss of Coverage” section. Select "Letter of Explanation" from the drop-down menu when uploading your documents.