After Open Enrollment ends, you can enroll in a private health plan through the CBC Health Insurance Marketplace for Costco Members only if you have a qualifying life event. This is a change in your life that can make you eligible for a Special Enrollment Period to enroll in health coverage. The types of life events that qualify and the documentation that is required for your enrollment are listed below.

Eligible Qualifying Life Events:

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Loss of job or termination of employment

Required Documentation:
Cobra Election Form
(or)
FMLA
(or)
HIPPA Certificate or Credible Coverage

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Reduction in hours or change of employment

Required Documentation:
Cobra Election Form
(or)
FMLA
(or)
HIPPA Certificate or Credible Coverage
(or)
Letter from employer on business letter-head confirming loss of coverage or reduction of hours

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Employer stopped contributing to my coverage or my dependents

Required Documentation:
Cobra Election Form
(or)
HIPPA Certificate or Credible Coverage
(or)
Letter from employer on business letter-head confirming loss of coverage or reduction of hours

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Cancellation of group coverage

Required Documentation:
Cobra Election
(or)
HIPAA Certificate or Credible Coverage
(or)
Letter from employer on business letter-head confirming the company group policy was canceled

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Covered under deceased member

Required Documentation:
Cobra Election Form
(or)
HIPPA Certificate or Credible Coverage
(or)
Death Certificate
(or)
Letter from employer on business letter-head confirming loss of coverage
(or)
Obituary (newspaper copy &/or mortuary notice)

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Coverage under Medicare

Required Documentation:
Copy of Medicare Card
(or)
Approval letter of entitlement from Social Security Office

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Child turns age 26

Required Documentation:
HIPPA Certificate or Credible Coverage
(or)
Letter from employer on business letter-head confirming loss of coverage
(or)
Copy of letter from the carrier explaining reason for dependent cancellation

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Loss of coverage under Medicaid or CHIP

Required Documentation:
Letter of notification of loss of coverage from the state

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Returned from Active Military Service

Required Documentation:
Certificate of Release of Discharge from Active Duty

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Disability status changed

Required Documentation:
Any relevant documentation that you have that shows when your qualifying event occurred

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Immigration status changed

Required Documentation:
Any relevant documentation that you have that shows when your qualifying event occurred

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Marriage

Required Documentation:
Marriage Certificate

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Divorce

Required Documentation:
Divorce Decree

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Move to new coverage area

Required Documentation:
Verification of recent address change
(or)
Current Utility Billing Statement confirming the California address
(or)
Lease or Renter’s agreement
(or)
Monthly mortgage statement
(or)
School Enrollment Record from the former state

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Birth of a child

Required Documentation:
Birth Certificate

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Adoption of a child

Required Documentation:
Certificate of Adoption

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Registration for Domestic Partner

Required Documentation:
Domestic Partner Certificate

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Medical Child Support Order

Required Documentation:
Letter from the court

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Loss of Exchange Coverage

Required Documentation:
Certificate of Coverage or evidence of other creditable coverage.

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Termination of COBRA

Required Documentation:
Letter from the COBRA administrator or prior insurance company verifying that you have exhausted your Federal COBRA benefits.

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Some unusual circumstances may be considered. If you are unsure please contact us:
Phone: (855) 332-3821     Email: CostcoQuote@cbcins.com