Confirm a Life Event

Examples of documents you may submit include: 

• Postal Service change of address confirmation letter 
• Mortgage or rental document, such as a mortgage deed or rental agreement with a start date at your new address 
• Bills or financial statements that show a change of address or newly started services at your new address 
• Letter from a government organization on official letterhead or stationery, that shows a change of address to your new address, such as a Social Security statement or a notice for SNAP (food stamps)  
• Homeowner’s or renter’s insurance policy or statement showing your current address. 
• Document showing you moved from outside the U.S., such as an Arrival/Departure Record (I-94/I-94A) (in a foreign passport or separately) that shows your date of entry into the U.S 

When you move, you must also submit documents to show you had health insurance or Minimum Essential Coverage (MEC) for at least one day during the last 60 days before you moved.

If you moved from outside of the U.S., you will need to include a document showing your old address was outside the U.S.

If you are homeless or in transitional housing, you can submit a reference letter from a person in your state who can confirm you live in the area permanently. This person must also prove their own residency by including one of the documents listed. Contact BeWell with questions. 

Documents must show you gained lawfully present status or citizenship within the past 60 days. Documents must include your name, immigration status and the date on which citizenship or lawful presence was gained.  

Examples of documents you may submit include: 

• Birth certificate 
• Certification of Report of Birth 
• Certification of citizenship or naturalization 
• Evidence of U.S. Civil Services employment before June 1, 1976 
• Federal or state census record 
• Final adoption decree 
• Immigrant visa on unexpired foreign passport 
• Medical records 
• Military record showing U.S. place of birth 
• Notice of Action (I-797) 
• Northern Marianas ID card 
• Official religious records 
• PASS card 
• Report of birth abroad of a U.S. citizen 
• School records 
• Section 1-1 of the Child Citizenship Act of 2000 documentation 
• Temporary I-551 Stamp (on passport or I-94/I-94A) 
• Arrival/Departure Record (I-94/I-94A) 
• Arrival/Departure Record in foreign passport (I-94) 
• Permanent Resident Card (Form I-551) 
• Tribal Affiliation card or document 
• Unexpired foreign passport 
• U.S. citizen ID card (Form I-197) or U.S. passport 
• Certificate of Eligibility for Exchange Visitor Status (DS-2019)
• Certificate of Eligibility for Nonimmigrant Student Status (Form I-20)
• Reentry Permit (Form I-327)  
• Refugee Travel Document (Form I-571)
• Employment Authorization Document (I-766)
• Administrative order staying removal issued by the Department of Homeland Security 
• Document indicating withholding of removal 
• Form I-360 prima facie determination notice
• Certification from U.S. Department of Health and Human Services (HHS) Office of Refugee Resettlement (ORR)
• Office of Refugee Resettlement (ORR) eligibility letter (if under 18) 

Documents must show proof of existing or prior coverage within the past 60 days.

Examples of documents you may submit include: 

Loss of Employer-Based Health Insurance Coverage

• Termination letter from prior carrier; email termination notices from prior carrier that can be validated may also be accepted (including and limited to carriers participating with the Exchange)
• Termination letter from a government provider (i.e., Medicaid)
• COBRA notice of termination of employer contribution to enrollment
• Employer letter of exhaustion to COBRA enrollment
• Dated letter from PEBPS
• Letter from the previous employer confirming loss of coverage
• Document from another state’s Marketplace
• Document proving you had student health coverage
• Paystub showing health coverage deductions

Loss of Medicaid

• Notice of Decision from DWSS (NOD)

Loss or Will Lose Minimum Essential Coverage

• Termination letter from prior carrier; email termination notices from prior carrier that can be validated may also be accepted (including and limited to carriers participating with the Exchange)
• Termination letter from a government provider (i.e., Medicaid)
• COBRA notice of termination of employer contribution to enrollment
• Employer letter of exhaustion to COBRA enrollment
• Dated letter from PEBPS
• Letter from the previous employer confirming loss of coverage
• Document from another state’s Marketplace
• Document proving you had student health coverage
• Letter or statement from TRICARE that shows the expiration or un-enrollment date of previous health coverage
• Letter from the Department of Veterans Affairs (VA) that shows the expiration date of previous health coverage
• Letter from the Peace Corps with the expiration date for any previous health coverage
• Paystub showing health coverage deductions

Documents must show you gave birth or adopted within the past 60 days.

Examples of documents you may submit include: 

Birth

• Birth certificate
• Birth confirmations
• Copy of the medical record from a clinic, hospital, physician, midwife, institution, or other medical provider showing the child’s date of birth
• Letter from a hospital, clinic, physician, or other medical provider attesting the child’s date of birth
• Copy of military record showing the child’s date and place of birth
• Copy of foreign birth record showing the child’s date and place of birth
• Copy of religious record showing the child’s date and place of birth 

Adoption

• Adoption letter or record show date of adoption dated and signed by a court official
• Government issued or legal document showing the date legal guardianship was established
• U.S. Department of Homeland Security immigration document for foreign adoptions
• Foster care papers dated and signed by a court official
• Government issued or legal document showing the date that the child was place in the home
• Court order showing the effective date of the order
• Medial support order

Documents must show proof of marriage/divorce within the past 60 days.

Examples of documents you may submit include: 

Marriage

• Marriage certificate
• Domestic legal document
• Marriage affidavit of support that’s signed and dated by the person who officiated the marriage or the official witness of the marriage
• A religious document showing who got married and the date of the marriage 

Divorce/Legal Separation

• Termination letter from prior carrier; email termination notices from prior carrier that can be validated may also be accepted (including and limited to carriers participating with the Exchange)
• Termination letter from a government provider (i.e., Medicaid)
• COBRA notice of termination of employer contribution to enrollment
• Employer letter of exhaustion of contribution to COBRA enrollment
• Dated letter from PEBPS
• Letter from the previous employer confirming loss of coverage
• Document from another state’s Marketplace
• Document proving you had student health coverage
• Paystub showing health coverage deductions
• Divorce decree/Certificate

Documents must show proof of income change within the past 60 days.

Examples of documents you may submit include: 

• Paycheck stubs showing employee information, pay date or pay period, and gross amount of pay
• 1040 federal or state tax return from the previous year if representative of attested income
• Wages and tax statement (W-2 and/or 1099, including 1099 MISC, 1099G, 1099R, 1099 SSA, 1099 DIV, 1099 SS, 1099 INT) showing first/last name, income amount, year and employer name (if applicable)
• Signed earning statement from your employer showing first/last name, company contact information and gross pay information, signed by the employer and dated
• Termination letter from employer
• Self-employment ledger documentation showing first/last name, company name, income amount
• 1040 SE with Schedule C, F, or SE (for self-employment income)
• 1065 Schedule K1 with Schedule E
• Unemployment benefits letter
• Tax return
• Most recent quarterly or year-to-date profit and loss statement

Loss of Eligibility for Employer Health Reimbursement Arrangement (HRA) 

• Proof of loss of HRA from employer with employee name and end date. 

Offered a Qualified Small Employer HRA or Individual Coverage HRA 

• Proof of gaining QSEHRA or ICHRA from employer with employee name, start date, end date and amount issued.  

Easy Enroll 

• Copy of the state tax form, showing that the box was checked to share information with Health Care Authority (HCA) and BeWell. 

Exemption Cancelled

• Exemption approval letter

Released from Incarceration 

• Copy of court order setting conditions of release.

Error – Due to Assister/Broker/Exchange/Benefit Display

• Statement letter with specific information regarding the error, which could include screenshots, contact information, emails, or any proof supporting the request.