www.coveredca.com
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23.99.0.12
Public Scan
Submitted URL: https://click.marketing.coveredca.com/?qs=502fc77bfb6d99bc50f757855501b75d07b7ea73fa72d4da0181383e42fff7262ed030547e2e2236cf332f901b4c...
Effective URL: https://www.coveredca.com/special-enrollment/?utm_source=SFMC&utm_medium=email&utm_campaign=D1-SEP-AF-2022&utm_content=&sf...
Submission: On August 04 via api from US — Scanned from DE
Effective URL: https://www.coveredca.com/special-enrollment/?utm_source=SFMC&utm_medium=email&utm_campaign=D1-SEP-AF-2022&utm_content=&sf...
Submission: On August 04 via api from US — Scanned from DE
Form analysis 5 forms found in the DOM
/site-search.html
<form class="form-inline my-2 my-lg-0 py-3 px-3 d-lg-none nav-site-search-form" action="/site-search.html">
<div class="position-relative w-100">
<div class="row">
<div class="col-12">
<div class="input-group d-flex align-items-start w-100">
<input type="hidden" class="d-none" name="index" value="1">
<input class="form-control nav-site-search-form__input nav-site-search-form__input--mobile" placeholder="Search" aria-label="Search" name="query" type="text">
<button class="btn border-left-0 border-radius-0 border-raidus-top-right-1 border-raidus-bottom-right-1 px-2 p-0 d-flex align-items-center border-gray-light" style="height: 40px;right: -1px" type="submit">
<i class="material-icons text-primary">search</i>
</button>
</div>
</div>
<div class="col-12 nav-site-search-form__invalid-feedback nav-site-search-form__invalid-feedback--red d-none" id="nav-site-search-input-invalid-feedback">
</div>
</div>
</div>
</form>/site-search.html
<form action="/site-search.html" class="flex-grow-1 nav-site-search-form" id="site-search-form-nav">
<div class="form-group mb-0">
<div class="row">
<div class="col-10 col-md-11">
<div class="input-group">
<div class="input-group-prepend">
<button type="submit" class="form-control btn btn-white btn-primary-on-hover h-100 d-flex align-items-center border border-right-0" style="left: -1px">
<i class="material-icons color-primary">search</i>
</button>
</div>
<label for="site-search-input-nav" class="sr-only" style="top:1000px;">Search</label>
<input type="text" class="form-control nav-site-search-form__input nav-site-search-form__input--desktop" style="border-top-right-radius: 50rem; border-bottom-right-radius: 50rem;" id="site-search-input-nav" name="query"
placeholder="Search CoveredCA.com">
<input type="hidden" class="d-none" id="site-search-index-nav" name="index" value="1">
</div>
</div>
<div class="col-2 col-md-1">
<div class="d-flex h-100 align-items-center">
<button class="bg-transparent border-0 p-0 search-active-toggle" type="button" style="height: 24px;"><i class="w-24px color-white material-icons">close</i></button>
</div>
</div>
<div class="col-12 nav-site-search-form__invalid-feedback nav-site-search-form__invalid-feedback--white d-none" id="nav-site-search-input-invalid-feedback">
</div>
</div>
</div>
</form><form class="sign-up__form subscription w-100" id="footer-subscribe">
<input type="hidden" name="StateSubsidy" value="true">
<input type="hidden" name="Source" value="footer">
<div class="row mx-0">
<div class="col-12">
<div class="form-group w-90 mx-auto">
<label class="text-dark m-0 pl-3" for="Name">First Name</label>
<input type="text" id="Name" name="Name" class="form-control form-control-sm border border-dark rounded-pill" placeholder="e.g. John">
</div>
</div>
<div class="col-6 ml-2">
<div class="form-group w-90 mx-auto">
<label class="text-dark m-0 pl-3" for="Zip">ZIP Code</label>
<input type="text" id="Zip" name="ZipCode" class="form-control form-control-sm border border-dark rounded-pill" placeholder="12345">
</div>
</div>
<div class="col-12">
<div class="form-group w-90 mx-auto mb-0">
<label class="text-dark m-0 pl-3" for="EmailAddress">Email*</label>
<input type="email" id="EmailAddress" name="EmailAddress" class="form-control form-control-sm border border-dark rounded-pill" placeholder="youremail@example.com" required="">
</div>
</div>
<div class="col-12">
<div class="w-90 mx-auto">
<span class="font-size-12px pl-3">* required</span>
</div>
</div>
<div class="col">
<button type="submit" id="gtm-sign-up" class="sign-up__submit-button--footer btn btn-sm btn-primary d-block mx-auto mt-2 mt-lg-0 px-5">Subscribe</button>
</div>
</div>
</form><form class="sign-up__form subscription" id="pop-up-subscribe">
<input type="hidden" name="StateSubsidy" value="true">
<input type="hidden" name="Source" value="Pop-up">
<div class="form-group">
<label class="text-primary" for="fNamePopUp">Enter First Name</label>
<input id="fNamePopUp" name="fNamePopUp" class="form-control border-primary">
</div>
<div class="form-group">
<label class="text-primary" for="ZipCode">Enter ZIP Code</label>
<input name="ZipCode" id="ZipCode" class="form-control border-primary">
</div>
<div class="form-group">
<label class="text-primary" for="eAddressPopUp">Enter Email Address (Required)</label>
<input type="email" id="eAddressPopUp" name="eAddressPopUp" class="form-control border-primary" required="">
</div>
<a class="text-center d-inline-block mb-4" href="/privacy">Privacy Policy</a>
<div class="loading text-center mb-3"><img src="//www.coveredca.com/images/loading.gif" alt="Loading..."></div>
<div class="col-8 offset-2">
<button id="signUp" type="submit" class="sign-up__submit-button btn btn-action w-100 gtm-lead-popup-subscribe" disabled="">Subscribe</button>
</div>
</form><form id="calculator-form" class="subsidy-calculator__form py-3 px-3 px-md-0" autocomplete="off">
<!-- Calculator API Error Message -->
<div id="subsidy-calculator__calculate-error-message" class="row mr-0 d-none">
<div class="col">
<div class="alert alert-danger text-center"> We are experiencing technical difficulties. Please try again later. </div>
</div>
</div>
<!-- Household Income, Zip and County -->
<div class="row mr-0 align-items-end">
<!-- Household Income -->
<div class="col-md-4 py-3">
<div id="household-income-component-01">
<div class="household-income-component">
<!-- HouseholdIncome Label -->
<div class="mb-2">
<label class="household-income-component__label font-weight-bold d-inline m-0" for="subsidy-calculator__household-income"> Household Income </label>
<span id="calculator-tooltip--household-income" data-toggle="tooltip" title="" class="font-18px text-primary cursor-pointer d-inline material-icons-outlined subsidy-calculator__tooltip-trigger" tabindex="0"
data-template="<div class="tooltip subsidy-calculator__tooltip" role="tooltip"><div class="arrow"></div><div class="tooltip-inner"></div></div>"
data-original-title="Household income refers to the estimated combined income of all family members for the year you plan to have coverage."> info </span>
</div>
<!-- HouseholdIncome Input -->
<div class="d-flex">
<input id="subsidy-calculator__household-income" class="household-income-component__input subsidy-calculator__input subsidy-calculator__input-income order-2" placeholder="28,000" type="text">
<div class="input-group-prepend order-1">
<span class="subsidy-calculator__dollar-sign">$</span>
</div>
</div>
<!-- HouseholdIncome Invalid Feedback -->
<div id="subsidy-calculator__household-income-invalid-feedback" class="household-income-component__invalid-feedback invalid-feedback"> Please enter a number </div>
</div>
</div>
</div>
<!-- ZIP -->
<div class="col-6 col-md-4 py-3">
<div id="zip-component-01">
<!-- ZIP Code Component -->
<div class="zip-code-component">
<!-- Label -->
<label class="font-weight-bold zip-code-component__label" for="subsidy-calculator__zip-code">ZIP Code</label> <br>
<!-- Input Group -->
<div class="d-flex">
<!-- Input -->
<input id="subsidy-calculator__zip-code" class="zip-code-component__input subsidy-calculator__input" placeholder="95834" type="text">
<!-- Location Button -->
<div class="input-group-append">
<span class="input-group-text icon-styles subsidy-calculator__form-control">
<button class="subsidy-calculator__flat-button gtm-calculator-geolocation zip-code-component__location-button" type="button">
<span class="sr-only">location</span>
<svg class="subsidy-calculator__icon-primary" focusable="false" viewBox="0 0 24 24" aria-hidden="true">
<path
d="M12 8c-2.21 0-4 1.79-4 4s1.79 4 4 4 4-1.79 4-4-1.79-4-4-4zm8.94 3c-.46-4.17-3.77-7.48-7.94-7.94V1h-2v2.06C6.83 3.52 3.52 6.83 3.06 11H1v2h2.06c.46 4.17 3.77 7.48 7.94 7.94V23h2v-2.06c4.17-.46 7.48-3.77 7.94-7.94H23v-2h-2.06zM12 19c-3.87 0-7-3.13-7-7s3.13-7 7-7 7 3.13 7 7-3.13 7-7 7z">
</path>
</svg>
</button>
</span>
</div>
</div>
<!-- Invalid Feedback -->
<div class="zip-code-component__invalid-feedback invalid-feedback"> Please enter a valid ZIP code </div>
</div>
</div>
</div>
<!-- County -->
<div class="col-6 col-md-4 py-3">
<div id="county-01" class="d-none">
<div class="county-component">
<label class="county-component__label font-weight-bold" for="subsidy-calculator__county">County</label> <br>
<select id="subsidy-calculator__county" class="county-component__input subsidy-calculator__select">
<option value="Sacramento">Sacramento</option>
</select>
</div>
</div>
</div>
</div>
<!-- Household Size, How many need coverage, coverage year-->
<div class="row mr-0 align-items-end">
<div id="household-size" class="col-6 col-md-4 py-3">
<div class="household-size-component subsidy-calculator__household-size">
<div class="mb-2">
<label class="household-size-component__label font-weight-bold d-inline m-0" for="subsidy-calculator__household-size"> Household Size </label>
<span id="calculator-tooltip--household-size" data-toggle="tooltip" data-placement="right" title="" class="font-18px text-primary cursor-pointer material-icons-outlined subsidy-calculator__tooltip-trigger" tabindex="0"
data-template="<div class="tooltip subsidy-calculator__tooltip" role="tooltip"><div class="arrow"></div><div class="tooltip-inner"></div></div>"
data-original-title="Include only the tax filer and any spouse or dependents (even if they aren’t applying for insurance)."> info </span>
</div>
<select id="subsidy-calculator__household-size" class="subsidy-calculator__select household-size-component__input">
<option value="1">1</option>
<option value="2">2</option>
<option value="3">3</option>
<option value="4">4</option>
<option value="5">5</option>
<option value="6">6</option>
<option value="7">7</option>
<option value="8">8</option>
</select>
<div role="alert">
<div id="subsidy-calculator__household-size-invalid-feedback" class="invalid-feedback household-size-component__invalid-feedback"> Household size must be the same or more than how many need coverage. </div>
</div>
</div>
</div>
<div id="need-coverage" class="col-6 col-md-4 py-3">
<div class="need-coverage-component">
<label class="need-coverage-component__label font-weight-bold" for="subsidy-calculator__need-coverage">How many need coverage?</label> <br>
<select id="subsidy-calculator__need-coverage" class="need-coverage-component__input subsidy-calculator__select">
<option value="1">1</option>
<option value="2">2</option>
<option value="3">3</option>
<option value="4">4</option>
<option value="5">5</option>
<option value="6">6</option>
<option value="7">7</option>
<option value="8">8</option>
</select>
<div role="alert">
<div id="subsidy-calculator__need-coverage-invalid-feedback" class="need-coverage-component__invalid-feedback invalid-feedback"> Cannot be more than the household size </div>
</div>
</div>
</div>
<div id="coverage-year" class="col-12 col-md-4 py-3" style="display: none;">
<div class="coverage-year-component">
<div class="mb-2">
<label class="coverage-year-component__label font-weight-bold d-inline m-0" for="subsidy-calculator__coverage-year"> When do you want to start coverage? </label>
</div>
<select disabled="" id="subsidy-calculator__coverage-year" class="coverage-year-component__input subsidy-calculator__select">
<option value="2022">Next year (2022)</option>
<option value="2021">This year (2021)</option>
</select>
<div class="coverage-year-component__invalid-feedback invalid-feedback" role="alert"> Please enter a coverage year </div>
</div>
<script>
const now = new Date();
if (now.getFullYear() > 2021) document.getElementById('coverage-year').style.display = 'none';
</script>
</div>
</div>
<!-- Age of members needing coverage -->
<div class="row">
<div id="ages" class="col-12">
<div class="ages-component pt-4">
<div class="mb-2">
<span class="ages-component__label d-inline-block font-weight-bold pr-2"> Age of People Needing Coverage <span id="calculator-tooltip--member-ages" data-toggle="tooltip" data-placement="right" title=""
class="font-18px text-primary cursor-pointer material-icons-outlined subsidy-calculator__tooltip-trigger" tabindex="0"
data-template="<div class="tooltip subsidy-calculator__tooltip" role="tooltip"><div class="arrow"></div><div class="tooltip-inner"></div></div>"
data-original-title="If under one year old, enter "1". Enter the age you and your household members will be on Jan. 1, 2022."> info </span>
</span>
<span id="member-age-label" class="d-none">Age of People Needing Coverage</span>
</div>
<!-- Household Member Ages Input Container -->
<div id="household-members" class="ages-component__ages-container d-flex flex-wrap m-0 w-100">
<div class="household-member-age mr-2"><label for="dynamic-age-input-1" class="font-weight-bold sr-only"><br> Age of People Needing Coverage<br> <br> info<br> <br> </label><input type="number" id="dynamic-age-input-1"
class="subsidy-calculator__household-member-age subsidy-calculator__input ages-component__age-input mr-2" placeholder="45"></div>
</div>
<div role="alert">
<div id="household-members-invalid-feedback" class="ages-component__invalid-feedback invalid-feedback"> Please enter a valid age for each person. </div>
</div>
</div>
</div>
</div>
<!-- UIB -->
<div class="row mr-0 align-items-end pt-4">
<div id="received-unemployment-benefits" class="col-md-8">
<div class="uib-component d-none">
<div class="font-weight-bold mb-2"> Received unemployment benefits in 2021? <span id="calculator-tooltip--uib" data-toggle="tooltip" data-placement="right" title=""
class="font-18px text-primary cursor-pointer ml-2 material-icons-outlined subsidy-calculator__tooltip-trigger" tabindex="0"
data-template="<div class="tooltip subsidy-calculator__tooltip" role="tooltip"><div class="arrow"></div><div class="tooltip-inner"></div></div>"
data-original-title="If yes, your household likely qualifies for Silver 94 plans with lower deductibles, copays, and coinsurance — all for as low as $1 per person."> info </span>
</div>
<div class="d-inline-block pr-5 radio-container">
<label for="yes-unemployment">Yes <input class="uib-component__yes-radio" type="radio" id="yes-unemployment" name="unemployment-benefits" value="yes">
<span class="custom-radio"></span>
</label><br>
</div>
<div class="d-inline-block radio-container">
<label for="no-unemployment">No <input class="uib-component__no-radio" type="radio" id="no-unemployment" name="unemployment-benefits" value="no" checked="">
<span class="custom-radio"></span>
</label><br>
</div>
<div id="received-unemployment-benefits--info" class="subsidy-calculator__uib-info d-none">
</div>
</div>
</div>
</div>
<!-- Calculate Button -->
<div class="row mr-0 mt-auto pt-4">
<div class="col-12 d-md-flex justify-content-md-end pr-md-5 py-3">
<div id="calculate">
<a href="#results-container" id="calculate-desktop" class="subsidy-calculator__calculate-button btn btn-primary px-0 px-lg-5 d-none d-sm-block gtm-calculator-calculate disabled">Calculate</a>
<a href="#results-container" id="calculate-mobile" class="subsidy-calculator__calculate-btn-mobile btn btn-primary px-5 d-block d-sm-none w-75 mx-auto gtm-calculator-calculate disabled">Calculate</a>
</div>
</div>
</div>
</form>Text Content
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SPECIAL ENROLLMENT
GET COVERAGE WHEN YOU EXPERIENCE A MAJOR LIFE CHANGE.
You can apply for a health plan outside open enrollment (or make changes to your
current plan) if you’ve experienced one of these qualifying life events, usually
within the last 60 days. Or, find out if you qualify for Medi-Cal.
Edit Life Event
Lost Health Insurance expand_less
* You lose Medi-Cal coverage.
* You lose your employer-sponsored coverage.
* Your COBRA coverage is exhausted. Note: Not paying your COBRA premium is not
considered loss of coverage.
* You are no longer eligible for student health coverage.
* You turn 19 years old and are no longer eligible for a child-only plan.
Edit Life Event
Turned 26 Years Old expand_less
You turn 26 years old and are no longer eligible for a parent’s plan.
Edit Life Event
Moved to or Within California expand_less
* You move to California from out of state.
* You move within California and gain access to at least one new Covered
California health insurance plan.
Edit Life Event
Married or Entered a Domestic Partnership expand_less
* One or both members of the new couple can use the special-enrollment period
to enroll in coverage.
Edit Life Event
A Child is Born, Adopted or Received into Foster Care expand_less
* A child is born, adopted or received into foster care. The entire family can
use the special-enrollment period to enroll in coverage.
* If you receive a child in foster care, you will need to indicate “adopted a
child” in the drop-down menu when you apply.
* For the birth or adoption of a child, or acceptance of a child into foster
care, you can choose to have coverage start on:
* The first day of the month following the birth, adoption, or placement in
your foster care of a child.
* On the date of the birth, adoption or placement in foster care.
* On the first day of the month following plan selection.
Edit Life Event
Change of Household Size
Edit Life Event
Domestic Abuse or Spousal Abandonment expand_less
Read more about this qualifying life event.
Edit Life Event
Affected by Wildfires expand_less
Your household experienced a natural or human-caused disaster (such as
wildfires) declared as a state of emergency in California.
Edit Life Event
Returned from Active Military Service expand_less
You have lost coverage after leaving active duty, reserve duty, or the
California National Guard.
Edit Life Event
Released from Jail or Prison
Edit Life Event
Gained Citizenship or Lawful Presence expand_less
You become a citizen, national, or lawful permanent resident.
Edit Life Event
Current Enrollees Who Experience a Life Event expand_less
* You are already enrolled in a Covered California plan and become newly
eligible or ineligible for tax credits or cost-sharing reductions.
* You are already enrolled in a Covered California plan and you lose a
dependent or lose your status as a dependent due to divorce, legal
separation, dissolution of domestic partnership, or death.
Edit Life Event
Additional Categories expand_less
See the full list of qualifying life events.
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3.5.4
CALCULATOR
×
ESTIMATE WHAT YOU’LL PAY
Estimate what you might pay for your plan with the help of our nifty calculator.
We are experiencing technical difficulties. Please try again later.
Household Income info
$
Please enter a number
ZIP Code
location
Please enter a valid ZIP code
County
Sacramento
Household Size info
1 2 3 4 5 6 7 8
Household size must be the same or more than how many need coverage.
How many need coverage?
1 2 3 4 5 6 7 8
Cannot be more than the household size
When do you want to start coverage?
Next year (2022) This year (2021)
Please enter a coverage year
Age of People Needing Coverage info Age of People Needing Coverage
Age of People Needing Coverage
info
Please enter a valid age for each person.
Received unemployment benefits in 2021? info
Yes
No
Calculate Calculate
Your Estimate $63 per month for a Silver plan. Bronze as low as $0. You may
qualify for: Covered California.
* You save $507 per month.
* Brand-name plans.
This isn’t an application for health coverage.
QUICK QUOTE
YOU MAY QUALIFY FOR
done
$63 per month
Medi-Cal
for a Silver plan.
Bronze plans as low as $0.
After financial help from: You may qualify for: You may qualify for: Covered
California both Covered California and no-cost or low-cost coverage through
Medi-Cal. no-cost or low-cost coverage
check_circle Financial Help: $507 per month
check_circle Bronze, Gold and Platinum plans also available
check_circle Coverage for children, adults and families
check_circle Free or affordable pregnancy coverage
check_circle Because of your income, you may be able to sign up now, even if you
don't have another qualifying life event.
Continue
This isn’t an application for health coverage. info
Total Subsidy: $506.80
Members going to cca: 1
Members going to medical: 0
Fed Fairshare: $62.90
FPL%: 217.39130434782606
Percentage of income: 0.0
SLS Benchmark cost: 569.70
SLS Rate: 394.53
Household Rating Factor: 1.44
Edit Calculator
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California works.
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