If a client is enrolling outside Open Enrollment, the Marketplace may ask for proof of their life event (like losing coverage, moving, marriage, etc.).
1 Always Start With This Form
Have the agent fill out the "Letter of Explanation: Confirm Life Events" by asking non-leading questions, completing the form on the clients behalf. This form is a catch-all. It tells the Marketplace:
- What happened
- When it happened
- And why the client cannot provide the document they asked for
This form should be used when the client got a letter asking for proof, but doesn't have the exact document(s) the Marketplace wants.
Note: This form does NOT replace real proof if the client has it. If they do have real proof, upload the real proof instead.
When Should This Form Be Used?
Use this form if:
- The client lost coverage but can't get a termination letter
- The client moved but doesn't have lease or utility bills
- The client got married but doesn't have the certificate yet
- The client was denied Medicaid but doesn't have the denial letter yet
- The client adopted, had a baby, or had a court order but can't get documents yet
- Or any time the Marketplace asks for proof and the client can't get it
What Must Be Filled Out
The form asks for:
- Name, DOB, Application ID
- Which life event applies: Loss of coverage, Move, Marriage, Medicaid/CHIP denial, Adoption, foster care, or court order
- The date it happened
- And why they cannot provide the requested documents
They should be honest and clear.
2 Upload It (Fastest)
After filling it out:
- Log in to HealthSherpa
- Go to their application
- Go to Application details → Upload documents
- Choose "Letter of explanation" as the document type
- Upload the completed form
Uploading is much faster than mailing.
If They Must Mail It
They should:
- Send a copy, not the original
- Include the barcode page if they have one
- Write their name and Application ID on every page
Mail to:
Health Insurance Marketplace
Attn: Coverage Processing
465 Industrial Blvd
London, KY 40750
Attn: Coverage Processing
465 Industrial Blvd
London, KY 40750
What Happens After They Send It
- The Marketplace will review it (usually takes 1–3 weeks)
- The client will get a message in their HealthCare.gov account
- If approved: The plan is sent to the insurance company and the client must pay the first premium before coverage starts
- If denied: They can upload more documents or a better explanation
Important Rules Agents Must Know
- Some SEPs cannot be used until documents are approved
- The client usually has 30 days after picking a plan to send documents
- If they miss the deadline, the enrollment can be canceled
- If the SEP is not confirmed, the sale does not exist
Official Healthcare.gov Instructions
For full rules and details, see:
Healthcare.gov
Special enrollment opportunities — Before you can start using your coverage, learn how to send documents to...
