Moving

If you are new to Idaho or moved within the state, you could be eligible to enroll with Your Health Idaho.

You could qualify for a Special Enrollment Period (SEP) if you experienced one of the following Qualifying Life Events (QLE) in the last 60 days:

Moving to Idaho from out of state
Moving to a new county or zip code in Idaho
Primary subscriber moved out of state

To qualify for a SEP, you must prove that you had qualifying coverage prior to moving and provide documentation of your new residence. Accepted documents include:

Verification Documents

Change of Address

Proof of health insurance coverage within 60 days prior to the move
Demonstrated exhaustion of eligibility for any COBRA benefits

And either:

Valid Idaho driver’s license or Idaho identification card
Idaho STAR card
U.S. Passport card
Idaho voter registration card

And

Proof of previous address and current address, including two of the following documents dated within 60 days of the change in address:
Student college enrollment letter
Automobile registration
Rental agreement
Home purchase agreement
Utility bills with previous and new addresses
Property tax notice with homeowner’s exemption
Home payment notice
Offer of employment
U.S. Postal Service change of address
DMV change of address certificate card

For most QLEs, you have 60 days from the date of your event to enroll in coverage. This means you must report your change, provide documentation, and select a plan and enroll by the end of the 60 days.

If you have questions, or would like more information, contact Your Health Idaho at 855-944-3246 or email Support@YourHealthIdaho.org.

How you report your QLE depends on if you already have coverage or receive a tax credit to help cover the cost of your insurance premium.

For existing accounts, please visit the Report a Change page to learn more about how to report your QLE.

For new customers, please complete the form below to submit your QLE to Your Health Idaho for review.

Request for Special Enrollment

Instructions

**Please keep a copy of all forms for your records**

If you believe you have a Qualifying Life Event that might be eligible for a Special Enrollment Period, you have 60 days from the date of your event to complete the following:

Report your Qualifying Life Event.
Provide documentation to prove the event and enrollment eligibility.
Select and enroll in a plan.

To Report your Qualifying Life Event

1. Report your Qualifying Life Event by filling out the form below.
2. Submit the form to YHI with any contact method described in “YHI Contact Information.”

First Name

Middle Name

Last Name

Date of Birth

Email Address

Phone Number

Street Address

Apt. / Ste. #

City

State

Zip Code

Type of Qualifying Life Event

A Qualifying Life Event could be eligible for a Special Enrollment Period. To see a brief description and required documentation visit our Special Enrollment Page.

Select the event(s) that best represents your situation (events must have taken place in the last 60 days):

Loss of Health Insurance

Gained a Dependent (Birth, Adoption, Court Appointed Ward)

Married / Divorced

Change of Address

Change in Financial Status

American Indian or Alaskan Native

Gained US Citizenship, Legal Presence, or Refugee Status

If your event is not listed please call Your Health Idaho at 855.944.3246.

Explain Your Qualifying Life Event

Please provide detailed information about your Qualifying Life Event.

Verification documents may be requested after enrollment is approved. Failure to provide verification may impact the enrollment status or effectuation of the policy.

Explanation of Qualifying Life Event:

Documentation Upload

To see a brief description and required documentation visit our Special Enrollment Page.

Supporting Documentation for Consideration

Do you need assistance completing this Qualifying Life Event Report?

You may appoint an authorized representative.

You can give a trusted person permission to communicate about this report with us, see your information, and act for
you on matters related to this appeal, including getting information about your appeal and signing your appeal on your
behalf. This person is called an “authorized representative.” If you ever need to change your authorized representative,
contact YHI.

Name

Role

Phone Number

Email Address

Notice of Privacy Practices

Your Health Idaho is committed to maintaining the privacy and security of personally identifiable information. Your
Health Idaho will use personally identifiable information only as permitted by Your Health Idaho's policies and as
required by law.

More information about Your Health Idaho's privacy and security practices and your rights is available on Your Health
Idaho's website at YHI Privacy Policy

If you need help understanding this form in another language, or if you are disabled and need help to use this form, please contact Your Health Idaho. There is no cost for assistance.

Read and Sign Below - Electronic Consent

Full Name

Moving

Verification Documents

Change of Address

Request for Special Enrollment

Instructions

To Report your Qualifying Life Event

Type of Qualifying Life Event

Explain Your Qualifying Life Event

Documentation Upload

Do you need assistance completing this Qualifying Life Event Report?

You may appoint an authorized representative.

Notice of Privacy Practices

Read and Sign Below - Electronic Consent

A copy of this submission will be emailed to you and any designated authorized representatives.