Proof of Eligibility for Special Enrollment
Some consumers who apply for coverage through Covered California in a special-enrollment period are asked to submit verification of their qualifying life event. If you receive a letter asking you to submit documents for your qualifying life event, check the Special Enrollment Acceptable Document List to select the right document to send to us.
If you cannot locate an acceptable document, you may submit a form attesting that you qualify for special enrollment due to a move or a loss of health insurance. View and print the attestation form for moving to or within California and the attestation form for loss of coverage. These attestation forms should not be used for anything other than responding to a Special Enrollment Letter.
You may submit your special-enrollment verification documents or attestation form to Covered California in one of the following ways:
Online: Upload your document here. To upload documents, scan or take a photo of the document you want to upload. Save it to your computer first. This upload link should not be used for anything other than responding to a Special Enrollment Letter.
By fax: (888) 217-9310
CA HBEX/Covered California
Special Enrollment Team
P.O. Box 1240
Rancho Cordova, CA 95741
By phone: (800) 752-6603
Representatives are available during these hours:
- Monday through Friday: 8 a.m. to 5 p.m.
- Closed Saturdays, Sundays and all state holidays.