Qualifying Life Events

Under certain circumstances, you can enroll or make changes to your healthcare coverage outside of the annual open enrollment period. These exceptions are known as “qualifying life events” (QLE) and can include: 

1. Loss of healthcare coverage: If you lose your healthcare coverage due to a job loss or age off a parent’s plan, you may be eligible to enroll in a new healthcare plan during a ‘special’ enrollment period. 
2. Change in income: Individuals who experience a significant change in income, such as losing a job or experiencing a decrease in income, may also be eligible for a special enrollment period. During this time, it’s possible to not only enroll in a new healthcare plan but also change your existing plan. 
3. Marriage or divorce: Should your marital status change, you may also be eligible to enroll in a new healthcare plan or make changes to your existing plan outside of the open enrollment period. 
4. Birth or adoption of a child: Whether because of birth, adoption or via foster care, a new child is a QLE. As with the other exceptions, during this special enrollment period, you can enroll in a new healthcare plan or make changes to your existing plan outside of the open enrollment period. 
5. Move to a new area: This exception may surprise you, but when you move to a new location, you may be eligible to enroll in a new healthcare plan or change your existing one. 

What’s likely not surprising is that the specific rules and eligibility requirements for these QLEs can vary depending on your employer or insurance provider. If possible, check with your employer and insurance company before these events occur to determine if you qualify for a special enrollment period (SEP). If your QLE allows you to take advantage of an SEP, you typically have a 60-day window in which to enroll in a new health insurance plan. 

What is a special enrollment period (SEP)? 

When you experience a QLE, you become eligible for a Special Enrollment Period (SEP). This is a period outside the annual open enrollment period that permits you to enroll in or make changes to your healthcare coverage. 

Qualifying life events that may trigger an SEP include situations such as losing job-based coverage, moving to a new coverage area, getting married, having a child, or experiencing certain other life changes that affect your health insurance needs. 

It’s important to note that not all life events qualify for a SEP, and the eligibility criteria can vary depending on your state and insurance provider. Additionally, you may need to provide proof of the qualifying life event in order to enroll in a plan outside of the open enrollment period. 

If you do not qualify for a SEP, don’t worry, you may be able to purchase a short-term health insurance plan. It’s important to note that these options may not provide the same level of coverage as a traditional health insurance plan, but they will provide coverage in the short term. 

How long are special enrollment periods? 

As with all the other deadlines mentioned, the specific rules and eligibility requirements of an SEP can vary, depending on your employer or insurance provider. SEPs may also differ in length, depending on the specific circumstances of the QLE and the rules of the employer or insurance provider. 

For example, if you were to lose your healthcare coverage because of a job loss, you may find you’re eligible for a 60-day SEP to enroll in a new healthcare plan. However, if you have a baby or adopt a child, you could be eligible for a shorter 30-day SEP to either add the new child to your existing healthcare plan or choose a new one. 

Just as with any QLE, it’s important to check with your employer or insurance provider to determine the length of the SEP for your specific situation. It’s also important to note that there may be specific deadlines or requirements for enrolling in or changing healthcare coverage during the SEP, so it’s important to act quickly and follow the rules to ensure you get the coverage you need.