Send documents to prove the loss of health coverage

If you receive a notice from the marketplace that you need to submit documents to confirm your loss of coverage, you can upload or mail the documents.

If your review says you also need to submit documents to confirm a recent move, in addition to confirming that you had health coverage for at least 1 day in the last 60 days, be sure to send both types of documents.

IMPORTANT: Download or send the documents as soon as possible. If you do not submit the documents by the deadline, you will not benefit from Marketplace coverage.

What documents can I submit?

Documents must show that you have lost eligible health coverage in the last 60 days or that you will lose coverage in the next 60 days. These documents should include your name and the date of loss of coverage. Documents you can submit:

• A letter from an insurance company, on letterhead or official letterhead, including:
  • A letter or premium invoice from your old insurance company that shows that you or your dependent have canceled health coverage.
  • A revocation letter from your insurance company indicating when coverage will no longer be available.
• A letter from an employer, on letterhead or official letterhead, which confirms any of this information about you or your spouse or dependent family member:
  • That your employer has abandoned or will abandon your coverage or benefits.
  • That your employer has stopped or will stop contributing to the cost of your coverage.
  • That your employer has changed or will change coverage or benefits, and your coverage will no longer be considered qualifying health coverage.
• A letter on the COBRA cover, such as a letter from an employer or health insurance company confirming these:
  • Your employer’s COBRA coverage offer as well as the start date of this coverage.
  • Your COBRA coverage has ended or will end, or when and when your employer stopped or will stop contributing to the cost of the coverage.
• A health care program document, on letterhead or official letterhead, including:
  • A letter from a government health program, such as TRICARE, Veterans Affairs (VA), Peace Corps, or Medicare, indicating when coverage has ended or will end.
  • A letter from your Medicaid or CHIP agency stating that your Medicaid or CHIP eligibility was denied and when it was denied or that your Medicaid or CHIP coverage has ended or will end.
  • A dated copy of your military release document (DD214).
• A letter if you have lost student health coverage, which indicates when coverage ended or will end. It should be on letterhead or official stationery.

You can also submit any of the documents from the list below. However, these documents may contain only part of the information that we need to confirm, so you will need to probably need to submit more than one of these documents:

• Pay stubs, if you have lost employer-sponsored coverage. You can submit:
  • 2 pay stubs from the past 1-3 months, one showing a deduction for health coverage and another showing the deduction ended within the past 60 days.
  • If a reduction in working hours caused you to lose coverage, you can submit a previous pay stub that shows you worked 30 hours or more and a deduction for health coverage, and a pay stub from the last 60 days that shows that you have worked less than 30 hours and no deduction for health coverage.
• Document indicating that you have lost your coverage due to divorce, legal separation, custody agreement or annulment within 60 days of submitting your request, including:
  • Divorce or annulment documents showing the date on which the liability for health coverage ends or proof that you have ceased to benefit from health coverage due to your relationship with your ex-spouse.
  • Legal separation papers indicating the date the responsibility for providing health coverage ends.
  • Other confirmation that you have lost or will lose coverage due to divorce, legal separation or cancellation stating when health coverage ends.
• Document indicating that you have lost your coverage due to the death of a family member, comprising:
  • A death certificate or public notice of death and proof that you had health coverage because of your relationship with the deceased, such as a letter from an insurance company or employer listing the names of people registered with the health plan.
  • Other confirmation that you have lost or will lose your coverage due to the death of a spouse or other family member.

You can upload more than one document if you have multiple documents to confirm loss of coverage. Select the green “DOWNLOAD DOCUMENTS” button on your application’s upload screen to submit each document.

What if I am in a plan that ended before the end of the calendar year?

If you lose or lose coverage from a plan other than the calendar year, you can submit a dated and signed copy of a written verification from an insurance agent, or a dated letter from your insurance company stating the end date of the coverage year. To submit, select “Other” from the drop-down menu.

What if I don’t have any of these documents?

You can submit a letter explaining what coverage you had, why and when you lost or will lose it, and why you cannot provide documents. Use this form and complete the “Loss of coverage” section. When filling out the form, select “Letter of Explanation” from the drop-down menu when you are on the document upload screen in the app.

How to download or send the documents?

Find out how to upload documents

Address:
Health Insurance Market Attention: Coverage Processing 465 Industrial Blvd London, KY 40750-0001