insurance

What Is a Qualifying Life Event?

7 Minute Read

When it comes to updating health insurance, we usually get a small window of time to do it—the one- to two-month period known as open enrollment. But what if something happens outside of open enrollment that turns your life upside down? What if you suddenly need more health insurance?

Needing to change your coverage during a time other than open enrollment isn’t a call to panic—so don’t! You may be eligible for a special enrollment period—as long as you’ve experienced a qualifying life event.

What is a qualifying life event?

A qualifying life event is a big change in your life—like having a baby, getting married, or losing your job—that suddenly increases your need for health insurance. When you experience a qualifying life event, don’t sit like a bump on a log! Call your health insurance agent and get the process going immediately. You usually have around 60 days to update your health insurance policy during a period called special enrollment, and the sooner you call, the sooner you’ll be covered.

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What are some types of qualifying life events?

One thing’s for sure; life’s full of changes—expected and unexpected. If any of those changes impact your health insurance needs, you’ve probably experienced a qualifying life event. Most health insurance companies separate these events into four main categories: changes in household, loss of health insurance, changes in residency, and complicated cases or other.

Changes in Household

A change in your household, whether it’s as exciting as birth or as sad as death, could leave your family without enough health insurance. If you’ve gone through one of the following changes in your family, you qualify for a special enrollment period:

  • You got married.

  • You divorced or legally separated from the person whose health insurance you shared.

  • You had a baby, or you adopted or fostered a child—in which case you would also need to update your term life insurance.

  • The policyholder of your family’s health insurance died.

Loss of Health Insurance

First, let’s be clear. If you stopped paying your premium or voluntarily cancelled your health insurance policy, that’s your fault. You won’t qualify for a special enrollment period simply because you changed your mind!

But if it was something outside your control, health insurance companies will show you some grace and give you time to enroll in another policy. The following four are the most common reasons for losing health insurance:

  • You lost health insurance through your job. Maybe the company you work for dropped your coverage. Or maybe you quit, were fired, or cut back on your hours. Whatever the cause, if you lose health insurance through your company, make time to find a new policy.

  • You lost health insurance provided by a private carrier. Similar to losing coverage through a company, you get a special enrollment period if you lose coverage through a private plan. You could find yourself out of health insurance if the company shuts down or if you move outside of its servicing area.

  • You lost Medicare, Medicaid or CHIP. Maybe you started earning more income and you lost coverage through one of these programs. If this happens to you, contact an insurance agent immediately. Ask about getting the same amount of coverage at a reasonable cost.

  • You turned 26. Hey, happy birthday! Time to get health insurance. Though it’s probably not the birthday gift you were expecting, turning 26 means you’re off your parents’ plan and on your own. You’ll get 60 days after your 26th birthday to enroll in a health insurance policy.

Changes in Residency

When you move, you usually need to create a huge to-do list—so don’t forget to add updating your health insurance! As long as you can prove you had health insurance 60 days before your move, you’re eligible for special enrollment. Health insurance companies consider any of the following a change in residency.

  • Moving to a different county or ZIP code
  • Moving to the U.S. from a foreign country or U.S. territory
  • Moving as a student to or from the place you attend school
  • Moving as a seasonal worker to or from the place you live and work

Complicated Cases

You may experience an event that affects your insurance needs but doesn’t fit into the three categories above. Hey, no worries! You may still qualify for a special enrollment period. Here are just three of the cases most commonly considered complicated cases.

1. Natural Disasters

Tornados. Tsunamis. Volcanos. If you had every intention to apply for health insurance but a nasty storm forced you to miss the deadline, you’d get more time to apply.

2. Technical Errors

We all make mistakes—including health insurance companies. If you enrolled for health insurance, but a technical error on the company’s website prevented the acceptance of your application, you’ll get a special enrollment period.

3. Domestic Abuse

Being a survivor of domestic abuse is tough. If you’re trying to separate from your abuser, but you’re insured under their health policy, you’ll get a special enrollment period to set up your own personal plan.

What kind of proof do you need to qualify?

After you’ve had a qualifying life event, you’ll need to prove it. Baby pictures on your phone or a couple of social media posts announcing your wedding won’t cut it! You must show real documentation proving that the qualifying life event happened and that you had health insurance before the event. (If you didn’t have health insurance before the qualifying life event, you may still be eligible; talk to your insurance agent about the specifics).

Here are the documents you’ll need for eight of the most common qualifying life events:

Marriage

  • Marriage certificate

Divorce

  • Divorce or annulment papers

  • Proof of prior health coverage 60 days before the divorce

Birth of your child

  • Birth certificate or application for the birth certificate or letter from your hospital showing proof of the birth

Adoption

  • Adoption record or placement for adoption

Loss of employer-sponsored health insurance

  • Termination letter from employer or termination letter from health insurance company

Death of policyholder

  • Death certificate

  • Proof of prior health coverage within the last 60 days

Turning 26

  • Proof of prior health coverage (under your parents’ coverage)

Moving

  • Proof you moved within the last 60 days (utility bills, rental or mortgage documents, or homeowner’s insurance policy)

  • Proof you had health insurance during the 60 days before your move

Each qualifying life event is different, so ask your insurance agent for a complete list of the documents you should present.

How do you submit documents?

After you’ve gathered your documents, you’ll need to send them to your health insurance company. Usually, you can do this online, but occasionally your insurance company will want to see either original documentation or certified copies. If this happens, you can mail the documents or drop them off in person.

Think you have a qualifying life event?

With medical debt being one of the top reasons for bankruptcy in America, getting the right amount of health insurance is super important for you and your household.(1) If you’ve gone through any of the qualifying life events we mentioned, don’t hesitate to update your insurance today! Qualifying life events don’t only affect health insurance; if you’ve had a major change, your other policies need a good review. Contact one of our insurance ELPs to start the process now.

Find an agent in your area who can help you get the best insurance coverage for your situation today!

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