What Is a Qualifying Life Event?

NEW! Listen to this article. (Read by George Kamel)

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 your health care needs suddenly change?

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 changes your health insurance needs. 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.

Want to make sure your family is covered? Check on your coverage before it becomes an emergency. Take our 5-Minute Coverage Checkup to make sure you have what you need.

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 the right 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.
• Someone covered by your health insurance has 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 are the four 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

Trying to pick up the pieces after a nasty storm or an earthquake causes damage to your home can be extremely stressful—and the last thing on your mind is signing up for health insurance. If you happen to miss the deadline, don’t worry. You’ll 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

First of all, if you or a loved one is in an abusive relationship, know that you’re not alone. If you need support, you can call the National Domestic Abuse Hotline, which is available 24/7, at 800.799.7233. And if you’re trying to separate from your abuser but you’re insured under their health policy, it’s important to know that 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:

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.

If you're shopping for life insurance, or just wondering how well your current policy meets your needs, we've got some next steps for you to look into right away.