Coveredca newsroomnews-releasesCovered California Creates Limited Special Enrollment Period 2025

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering your name in the designated field. This is essential for identifying your application.
3. In the next section, provide a detailed explanation of why you cannot obtain a document to verify your qualifying life event. Be as specific as possible.
4. Indicate the reason for your coverage termination through employment in the following field. This helps clarify your situation.
5. Fill in the name of your previous health carrier and the last date of coverage. These details are crucial for processing your request.
6. Lastly, enter your member number and group number accurately to ensure proper identification within the system.
7. Sign and date the form at the bottom, confirming that all information provided is true under penalty of perjury.

Start using our platform today to easily complete and submit your enrollment form online for free!