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Small Group: Special Enrollment Quick Reference Chart

Life-Changing Qualifying Event (QE) – Mini-Open Enrollment

Any of the following events would allow the subscriber to change plans and/or add themselves or other family members with the effective dates as listed.

Life-Changing Qualifying Event (QE)
Qualifying Event Effective Date Determination Documentation
Newborn Date of event No documentation, but DOB must be on application
Adoption** Date of event Court documentation showing date when court order effective
Marriage / Domestic partnership First of the month following date application is received -
Legal guardianship** / Court order dependent**
Date of event Court documentation showing date when court order effective

** Must be routed to case coordinator


Loss of minimum essential coverage

Includes (but are not limited to) any of the following events which resulted in a loss of minimum essential coverage, NOT INCLUDING voluntary termination, failure to pay premiums or situations allowing rescission.

Effective date determination

Oregon: Up to 30 days AFTER loss:

  • First of the month following date application is received

Washington: Up to 60 days AFTER loss:

  • First of the month following date application is received
Loss of minimum essential coverage
Qualifying Event Documentation
Loss of coverage due to termination of employment or reduction of hours

One of the following:

  • PCC*
  • Front and back of previous carrier ID card
  • Confirmation of work-hour reduction
    including termination from employer (must be
    on employer letterhead and signed by
    employer management)
Loss of coverage due to death of a covered employee

One of the following:

  • PCC*
  • Front and back of previous carrier ID card
Loss of coverage due to covered employee became entitled to benefits under Medicare

One of the following:

  • PCC*
  • Front and back of previous carrier ID card
  • Eligibility document
Loss of coverage due to divorce or legal separation

One of the following:

  • PCC*
  • Front and back of previous carrier ID card
Loss of coverage due to maximum age dependent

One of the following:

  • PCC*
  • Front and back of previous carrier ID card
  • Max age letter from previous carrier

Management review

These QEs require Health Net Management review and approval
Qualifying Event Effective date determination Documentation
The qualified individual's, or his or her dependent's, enrollment or non-enrollment in a health plan is unintentional, inadvertent or erroneous and is the result of the error, misrepresentation or inaction of an officer, employee or agent of the health plan or its instrumentalities as evaluated and determined by the health plan. Management review and approval Letter from applicant supporting the qualifying event
The health plan in which the enrollee, or his or her dependent, is enrolled substantially violated a material provision of its contract. Management review and approval Letter from applicant supporting the qualifying event

* Abbreviations:

  • EOM – End of month
  • PCC – Prior Coverage Certificate
SEP submission time frame
SEP Time Frame
All SEPs except loss of coverage 30 days after event
Loss of coverage only
  • 30 days before date of event
  • 30 days after date of event
  • The default processing date for SBG is based on the qualifying event, including when enrollment would thus be retrospective. With the exception of birth or adoption, in the case that there is an appeal or grievance case, or threat of one, please permit an effective date of "first of the month following the date the enrollment form is received." This later date still aligns with regulatory time frames, even though the earlier, default date is compliant and to the benefit of the member in most cases.


    Health Net Health Plan of Oregon, Inc. is a subsidiary of Health Net, Inc. Health Net is a registered service mark of Health Net, Inc. All rights reserved.