What Is A Qualifying Life Event For Health Insurance?

Every year, you have the opportunity to purchase health insurance during open enrollment. What many people don’t know is that they may be able to shop for health insurance outside open enrollment if they have a Qualifying Life Event (QLE) such as moving out, divorce, getting married, and having a baby. After these special circumstances, you can either sign up or change your insurance plan.

Unfortunately, millions of people who qualify for a QLE special enrollment don’t know it – only 15% or eligible individuals use the qualifying event to enroll in a new plan or change their existing coverage. A study by the Robert Wood Johnson Urban Institute found out that approximately 12.9 million individuals could use a special enrollment period (SEP) to enroll and 20.6 million could use short-term coverage to fill in the gaps.

But what is a Qualifying Life Event exactly? This is a major change in your life that affects your health and may also impact your insurance needs or qualification for your current health coverage or subsidies. What are some examples of qualifying life events? There are different kinds, which include changes in employment, income, location, and family status.  

What’s a special enrollment period (SEP)? This a 60-day period that allows you to enroll in or change your current plan outside open enrollment prompted by a qualifying life event. So, you only have 60 days from the event that qualifies you for enrollment.

Some situations, however, aren’t considered qualifying life events, especially when it comes to health insurance. For instance, if the circumstances meet the criteria for a qualifying life event, but it doesn’t affect your health plan benefits, it may not be eligible. Loss of a family member or divorce that will not result in a change of coverage, for example, may not qualify you for a special enrollment period. Also, if you moved out for reasons such as a getaway, or if your insurance was canceled for a non-payment.

You may be asked to prove if you are eligible for a Special Enrollment Period, which needs to be provided within 30 days of selecting your plan. There are also special situations called “complex issues,” which fall outside the examples described above, and may qualify you for special enrollment. These special circumstances are evaluated based on the type of case.

If you are not eligible for a special enrollment window, you can apply for Medicaid or CHIP. Other options include short-term health insurance and membership health insurance. Some of these may not be the best solutions, but they can help you find affordable health care at least until the next enrollment period. If you are reading this, you missed the deadline to sign up for health insurance and may be wondering whether you qualify for a specific life event and special enrollment period. Allow one of our agents help you. Request a quote here.

  • https://www.healthcare.gov/glossary/qualifying-life-event/

  • https://www.healthcare.gov/sep-list/

  • https://www.healthcare.gov/blog/major-life-event-special-enrollment-period/


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