Different Qualifying Life Events for a Special Enrollment Period

special enrollment period

Special Enrollment Period and Qualifying Life Events

To enroll in health insurance plan outside the annual enrollment period, which takes place between November 1st and December 15th, you need to have a Special Enrollment Period.  A Special Enrollment Period (SEP) is a period during which individuals and their entire household can shop for and enroll in a health insurance plan (or change to a different plan if already enrolled). An SEP can occur at any time during the year, including during the Open Enrollment Period. This information below outlines all the possible triggering events and the specific enrollment details associated with each, as implemented in accordance with State and Federal regulations.

Throughout the year, including outside of Open Enrollment, you can enroll in or change your health insurance plan if you experience a qualifying life event making you eligible for a Special Enrollment Period.

What exactly are Qualifying Life Events (QLE)?

A QLE is a change in circumstances – such as getting married, having a baby, or losing health insurance coverage – which, if experienced, allows the individual to enroll in coverage through the marketplace or off exchange plans.

Generally, qualified customers have 60 days from the date in which the life event occurs to apply and enroll in a qualified health insurance plan. This 60-day period is referred to as a Special Enrollment Period (SEP). Customers may be asked to produce documentation of their QLE, which they should try to have handy when they apply.

 

Common life events that could qualify you to enroll in coverage.

cancelled

Loss of current health coverage

  • Losing eligibility for Medical Assistance, also referred to as Medicaid or CHIP.
  • Losing existing, qualified health coverage (including job-based coverage).
  • Losing coverage through a parent’s plan (i.e. turning  age 26).
Changes in residence

Changes in residence

  • Moving to a different area within the same state or to a different state.
  • A student moving to or from the place where they attend school.
  • A seasonal worker moving to or from the place they both live and work.
  • Moving to or from a shelter or other transitional housing.
household

Changes in household

  • Getting married or divorced.
  • Having a baby or adopting a child.
  • Passing of a family member.
other qualifying events

Other qualifying events

  • Changing income that affects qualifications for coverage.
  • Gaining memberships in a federally recognized tribe or a status as an Alaska Native Claims Settlement Act (ANCSA) Corporation shareholder.
  • Gaining a qualifying immigration status.
  • Becoming newly eligible for financial assistance based on a change in income.
contact us

Can’t find your QLE?

If you have doubts about your qualifying life event or not sure if your still within the time bracket to apply for health coverage, contact us to walk you through it. You can simply contact us or schedule a call with a licensed agent.

Certain states may have a Special enrollment period due to a natural disaster or inclement weather. Contact us if you believe  you were affected. Note that you are also eligible for a qualifying event in some rare occurrences where the current plan is cancelled or discontinued in your service area.

What documentation can I submit to prove a Qualifying Life Event (QLE)?

In this table you will find the types of documentation you can submit as proof for different types of QLEs. If multiple types of documents are listed, you only need to submit one type of document from the list.

If
Submit one of these documents
You got married
Fully executed Marriage Certificate
You got divorced
Divorce Decree, or Legal Separation Papers
You gave birth or adopted a child
Hospital Discharge papers; Official birth certificate; notice of legal adoption; hospital certificate with footprints.
You lost eligibility in other benefits
Coverage termination notice from a government agency; HIPAA Certificate of Credible Coverage
You gained eligibility in other benefits
Offer Letter from your spouse or domestic partner's new employer showing your benefits elibility; Payroll stub showing benefit deductions have begun
Your dependent passed away
Certified legal death Certificate for your dependent
You or your dependent reached the maximum age of 26
No documentation required

What type of insurance can I get if I don’t have any of the above Qualifying Life Events?

If you don’t have a valid qualifying life event that opens a Special Enrollment period, here is your alternative options for health insurance coverage:

  1. You can sign up for a Short Term Health Insurance, as long as it is allowed in your state. Check this article for states that bans the sale of Short Term health insurance.
  2. You can enroll in an Indemnity Plan that reimburse you a set dollar amount per medical claim. Carriers like UHC, National General, and Pivot Health offer these plans.
  3. Consult with an insurance agent or broker to discuss available options in your area. Our agents are here to help al the time, contact us to learn more.
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