Qualifying Life Event

There are many rules and guidelines involved in health insurance. One of these is the Open Enrollment period which is the specific period every year that you are allowed to enroll in new health insurance benefit plans or make any changes to existing health insurance plans. But what can you do if you want to make changes to your benefit plan outside the open enrollment period? Is it possible? It will depend on the reason behind it. Did a qualifying life event happen? Let’s talk about qualifying life events below. 

What is a “qualifying life event”? 

In the health insurance space, a qualifying life event refers to any change in an individual’s life circumstance or situation that can make them eligible to buy a health insurance plan or make changes to an existing benefit plan even if it is not during the open enrollment period. Common examples of qualifying life events are getting married, having a baby, or a death in the family. 

In this case, a qualifying life event can allow the individual to make these changes in a Special Enrollment Period, named such because it falls outside the yearly designated open enrollment period. A special enrollment period provided by health insurance providers usually lasts 60 days after the occurrence of a qualifying life event during which an individual can make the necessary changes in their health insurance plans or sign up for a new plan. While this is the usual duration of a special enrollment period, it is best to contact your health insurance provider for more detailed information on the enrollment process. 

What are examples of a qualifying life event? 

A qualifying life event may be planned or unplanned. There are generally four types of qualifying life events:

• Loss of health insurance
• Changes in the household
• Changes in residence
• Other qualifying changes

Let’s take a look at examples under each category. Note that these are just some examples and not a complete list. 

Loss of Health Insurance

• Losing an existing health coverage such as a job-based, COBRA, or student plan
• Losing eligibility for Medicare, Medicaid, or the Children’s Health Insurance Program (CHIP)
• Turning 26 years old and losing coverage via a parent’s plan
• Losing health insurance for any other reason except not paying premiums

Changes in Household

• Getting married
• Getting separated
• Getting divorced
• Having a baby
• Adopting a child
• Receiving a foster child
• Death of someone on your health insurance policy

Changes in Residence

• Moving to a different county or zip code
• For seasonal workers, moving to or from a work location
• For students, moving to or from school
• Moving in or out of a shelter or transitional housing
• Moving to the United States from a U.S. territory or foreign country

Other Qualifying Changes

• Changes in income that impact Medicaid coverage eligibility
• Becoming a member of a federally recognized tribe
• Becoming a U.S. citizen
• Being released from prison
• For AmeriCorps VISTA members, starting or ending their service

Aside from these qualifying life events, there can also be what is called an “exceptional circumstance” or “special circumstance” that may allow a person a special enrollment period. 

Here are some examples of a special enrollment period:

• If you were unable to enroll because of a natural disaster, such as an earthquake, massive flooding, or hurricane
• If you were unable to enroll because of an unexpected hospitalization or temporary cognitive disability
• If someone working in an official capacity to help you in enrolling made a mistake in enrollment or prevented you from enrollment
• If a technical error happened when you applied or if wrong policy data was displayed
• If you were determined to be ineligible for Medicaid or Children’s Health Insurance Program (CHIP) after the open enrollment period ended
• Gaining a new dependent or becoming a dependent because of child support or other court order
• Surviving domestic abuse or spousal abandonment and want to enroll in your own health plan that is separate from the abuser
• Filing an appeal and winning an appeal after incorrect eligibility determination

Remember that a qualifying life event is a change that impacts your health insurance needs. It has to be an event that alters your health benefit plans.