Individual and group health coverage sold across the United States only allows new membership during the annual open enrollment period. This is meant to ensure that everyone purchases health insurance at the right time, even if they don’t want it for the moment. If enrollment is left open throughout the year, people would only purchase coverage when they are sick, causing the entire system to break down.
However, there are exceptions to the annual enrollment period. These are the qualifying life events, and if you experience any of them, you are allowed to purchase new coverage or change your existing coverage even if it is before or past the annual enrollment period.
Read on to learn more about qualifying life events for health insurance and when you can seek to buy or change your health insurance coverage outside the annual enrollment period. Let us get started.
What Is a Qualifying Life Event?
In simple terms, a qualifying life event refers to a significant change in one’s life that allows them to alter an existing health insurance policy or sign up for a new policy outside the official enrollment period.
Without a qualifying life event, you will be forced to wait until the next open enrollment period before making any changes to your existing policy.
Some of the common qualifying life events include the death of a spouse, change in marital status, birth/adoption of a child, and so on.
We shall cover these events in detail in the sections below:
How Does the Concept of Qualifying Life Event Work?
Once something that qualifies to be classified as a qualifying life event happens in your life, you will have up to 60 days to alter or change your existing health insurance plan. All you have to do is contact your health insurance as soon as possible to commence the process.
In most cases, your health insurance provider will request you to prove eligibility for special enrollment and provide a copy of your denial letter if you are trying to reapply because CHIP or Medicaid turned you down previously.
If you have gained a dependent through a court process, you will be required to provide the court order that led to the event.
The proof will be required within 30 days of requesting a special enrolled period from your plan provider. The insurance company will send you regular notices about your status and whether there are any rules you haven’t met or proof you haven’t sent their way.
Categories of Qualifying Life Events
There are four main categories of qualifying events, namely:
- Loss of health insurance.
- Changes in residence.
- Changes in a household.
- Other qualifying changes.
Let us evaluate each one of them closely and see what falls under each one of them:
1. Loss of Health insurance
When you turn 26 years old, and lose your health coverage through your parent’s health insurance plan, you qualify to enroll for coverage no matter the time of the year.
You also qualify for special enrollment when you lose your job-based coverage, lose eligibility for Medicaid, Medicare, or the Children’s Health Insurance Program (CHIP), or lose your current health insurance coverage for any other reason such as not paying the premiums.
2. Changes in Residence
You are eligible for special enrollment if you move to a different county or ZIP code when you are a seasonal worker and move into and out of your workstation.
Moving to the United States from a U.S territory or foreign country and moving in or out of transitional housing are also considered qualifying life events.
3. Changes in Household
When you get married, divorced, or legally separated from your spouse, you may qualify for special enrollment.
You could also alter or change your existing health insurance coverage when you have a baby, adopt a child, receive a foster child, or someone on your current policy dies.
4. Other Qualify Changes
The other qualifying changes include any changes to your income that may affect your Medicaid coverage, becoming a member of a federally recognized tribe, being released from incarceration, or if you have become a U.S citizen for the first time.
In addition to the events mentioned above, there are certain times when exceptional circumstances, commonly referred to as special circumstances, can help you qualify for a special enrollment period.
Do We Have Non-Qualifying Life Events?
While a qualifying life event is a significant life-changing circumstance that may impact your current health plan, circumstances that may not change your plan are considered non-qualifying.
For instance, divorce or the death of a family member may not get you a special enrollment period if it doesn’t change your current health insurance plan’s coverage in any way.
Other events that may not count as qualifying life events include temporary relocation, voluntary dropping your current healthcare plan, or having your current plan canceled by the provider for non-payment.
Who Is Eligible for Qualifying Life Events?
Since each qualifying life event is different, anyone with health insurance coverage can qualify. The only thing you need to do is present proper documentation showing how the event changed your life and how it impacted your health insurance plan.
You will be accorded a special enrollment period as long as you can prove that you have lost coverage or need to change your current coverage to cater to your needs.
Some of the documents that may be requested when you file for notice of special enrollment with your current provider include:
- Divorce papers or death certificates showing that the family member who was providing you with health insurance has either died or left you.
- Birth certificates, marriage certificates, or child adoption records showing that you have added family members and need more coverage.
- Mortgage records or new rental agreements showing that you have relocated and your current plan can no longer cover you in your current location.
Can I Cancel My Current Health Insurance Plan without a Qualifying Life Event?
You can always cancel your health insurance plan anytime, anywhere. However, it is essential to keep in mind that once you cancel your current plan, you cannot enroll again without a qualifying life event until the next annual open enrollment period.
During this time, you will have no form of health insurance coverage which can prove costly should you fall sick and get admitted to the hospital.
On the other hand, you cannot cancel an employer-provided health insurance plan at any time. If you want to cancel an employer-sponsored plan outside of your employer’s open enrollment period, it will definitely need a qualifying life event.
What Are the Alternatives to Qualifying Life Events?
If you don’t qualify for a special enrollment period yet and still need coverage, you can look into the Children’s Health Insurance Program (CHIP) or Medicaid, which always accepts new applications. You can also look into membership health insurance or a temporary health insurance plan.
You can obtain membership health insurance if you belong to an organization that offers it. If you are still a student and your school offers a student health plan, that will be the best option.
A temporary or short-term health insurance plan can help you in case of a catastrophic event but may not be an ideal long-term solution because the coverage is always minimal.
The Bottom Line
Qualifying life events are not always defined. That is why our experienced health insurance agents are here to help you better understand if what you have just experienced qualifies to give you a special enrollment period.
We shall help you review your options to ensure you are always covered. Talk to us today and let us help you find the right coverage for your needs.