Sec. 14.35.07.19. Special Enrollment Period — Other

A. An enrollee or an enrollee’s dependent is eligible for a special enrollment period if the enrollee or enrollee’s dependent is determined newly eligible or ineligible for APTC or has a change in eligibility for CSR. The effective date of coverage for enrollees determined eligible for a special enrollment period under this section is the first day of the month after the Individual Exchange receives the QHP selection.

B. A qualified individual who is an Indian, or becomes a dependent of an Indian, may enroll in a QHP or change from one QHP to another, no more than once per month.

C. A qualified individual or a qualified individual’s dependent is eligible for a special enrollment period if the qualified individual or qualified individual’s dependent who was not previously a U.S. citizen, a U.S. national, or lawfully present in the U.S. becomes a U.S citizen, a U.S. national, or lawfully present in the U.S.

D. A qualified individual or a qualified individual’s dependent is eligible for a special enrollment period if the qualified individual or qualified individual’s dependent who was previously incarcerated becomes newly eligible for a QHP due to satisfying the requirements under 45 CFR §155.305(a)(2).

E. A qualified individual or qualified individual’s dependent is eligible for a special enrollment period if the qualified individual receives a certificate of exemption under Regulation .20 of this chapter for a hardship based on the eligibility standards set forth in 45 CFR §155.605(d)(i)-(iii) for a month or months during the coverage year, and based on the circumstances of the hardship attested to, the qualified individual is no longer eligible for a hardship exemption within a coverage year but outside of an open enrollment period.

F. A qualified individual or a qualified individual’s dependent is eligible for a special enrollment period if a qualified individual with a certificate of exemption under Regulation .20 of this chapter for a hardship based on the eligibility standards for an exemption, as set forth in 45 CFR §155.620(b), the change resulting from a redetermination is implemented, and the qualified individual or the qualified individual’s dependent is no longer eligible for an exemption.

G. A qualified individual, an enrollee, a qualified individual’s dependent or an enrollee’s dependent is eligible for a special enrollment period if the qualified individual or qualified individual’s dependent experiences a change or triggering event not included in this regulation under 45 CFR §155.420.

H. A qualified individual, an enrollee, a qualified individual’s dependent, or an enrollee’s dependent has 60 days from the date of the change in circumstances creating eligibility for a special enrollment period under this regulation to notify the Individual Exchange of the change in circumstances and select a QHP.

I. The effective date of coverage for a qualified individual, an enrollee, a qualified individual’s dependent, or an enrollee’s dependent who is determined eligible for a special enrollment period under §§B—G of this regulation is:

(1) The first date of the following month for QHP selections received by the Individual Exchange between the first and the 15th day of the month; or

(2) The first day of the next following month for QHP selections received by the Individual Exchange between the 16th and the last day of a month.