HomeMust ReadWhat Is Considered A Qualifying Event For Health Insurance

What Is Considered A Qualifying Event For Health Insurance

What Are My Options If I Leave A Union

Avera Health Plans – Qualifying Event for Health Insurance

Lets say though, that youve decided to walk away from a union for good. Leaving a union, for any reason, brings with it some uncertainty. You may have had close relationships there and a variety of benefits including health insurance.

No need to worry if you lost health coverage. You can now find insurance on your own. Losing group health coverage from your employer or union is a qualifying event that opens a special enrollment window when you can find an individual health insurance plan.


Returning from Military Service

Losing your coverage for returning from the military opens a Special Enrollment period when you can pick your own health insurance plan.

What Constitutes An Involuntary Loss Of Insurance

The term involuntary loss of health insurance can be confusing. For example, imagine that you voluntarily leave your job and lose the insurance you get through your employer. That is considered an involuntary loss of insurance. Other examples of an involuntary loss of insurance include:

  • Divorce
  • Death of the policyholder

What Are Some Examples Of Qualifying Events

On both the individual and family health insurance market, including on-exchange and off-exchange coverage, there are many examples of major life events that may be considered a qualifying event, allowing you to freely make changes to your coverage.

The following major life events are usually considered qualifying events by most insurance providers under the Affordable Care Act :

  • The birth or adoption of a child.
  • A change in marital status, including getting married or getting divorced.
  • A loss of other health insurance coverage.
  • A permanent move to a new area.
  • A change in income that affects your subsidy eligibility or moves you out of Medicaid eligibility.
  • Becoming a U.S. citizen or lawfully present resident.

Recommended Reading: Can A Married Dependent Be On Health Insurance

Applying For A Special Enrollment Period

If youve experienced one of the events above and want to apply for a special enrollment period, youll need to do so through Healthcare.gov or your state exchange.

How you apply depends on whether youve had a qualifying life event or another special circumstance.

If you have a qualifying life event, you can apply online. If youre not sure whether you qualify, Healthcare.gov can screen you by asking you a few questions on any events youve experienced that would open a special enrollment period.

Once youve determined youre eligible, you can start an application for insurance coverage or log in to your existing account.

If you have a special circumstance rather than a qualifying life event, contact the Marketplace directly. You can reach the call center at 1-800-318-2596. The representative will ask about your situation and help you determine whether it qualifies you for a special enrollment period.

Tempted To Go Without Health Insurance

Health Insurance Qualifying Event : How Do You Buy Health ...

You might not be a huge fan of health insurance companies right now. We get that, but going without insurance just doesnt make sense. Youd be taking too big of a risk.


Not Eligible for Medicaid

You may qualify for special enrollment to purchase a health insurance plan if you lose your coverage under Medicaid or Childrens Health Insurance Program .

You May Like: How To Get Health Insurance In California

What Are The Different Types Of Qualifying Life Events

Losing your health insurance

  • Losing your coverage through Medicare, Medicaid, or CHIP
  • Losing a health insurance plan you bought yourself

Changes in your household size

  • Getting married
  • Having a baby or adopting a child
  • Placing a child in foster care
  • Losing coverage through a divorce or legal separation
  • Losing coverage due to a death of a family member

Changes in your residence

  • Losing coverage when moving to a new county or ZIP code
  • Losing coverage when moving to or from the place you attend school
  • Losing coverage when moving to or from transitional housing
  • Losing coverage as a seasonal worker when moving to or from the place where you both live and work
  • Moving to the United States from a foreign country or United States territory

Additional qualifying life events

Do You Qualify For A Special Enrollment Period

If there have been major changes in your life, you may qualify for a Special Enrollment Period. If one or more of the qualifying life events have occurred, you should contact your health insurance company to ensure your eligibility. Even if you are qualified for this enrollment period, you will need to provide proof of these changes. This proof varies widely depending on the specific qualifying life event. Contacting the insurance company for their specific requirements may be the best option.

Don’t Miss: How To Get Temporary Health Insurance

Who Doesnt Need A Qualifying Event

In some circumstances, enrollment is available year-round, without a need for a qualifying event:

  • Native Americans/Alaska Natives as defined by the Indian Health Care Improvement Act can enroll anytime during the year. Enrollment by the 15th of the month will result in an effective date of the first of the following month. Native Americans/Alaska Natives may also switch from one QHP to another up to once per month .
  • Medicaid and CHIP enrollment are also year-round. For people who are near the threshold where Medicaid eligibility ends and exchange subsidy eligibility begins, there may be some churning during the year, when slight income fluctuations result in a change in eligibility.

    If income increases above the Medicaid eligibility threshold, theres a special open enrollment window triggered by loss of other coverage. Unfortunately, in states that have not expanded Medicaid, the transition between Medicaid and QHPs in the exchange is nowhere near as seamless as lawmakers intended it to be.

  • Employers can select SHOP plans year-round. But employees on those plans will have the same sort of annual open enrollment windows that applies to any employer group plans.

What Are My Options After Cobra Expires

Health Insurance Qualifying Event When Open Enrollment is Over

Is your COBRA coverage about to expire? After months of not worrying about health insurance, do you know what to do next?

Heres the good news: Rolling off of COBRA coverage is a qualifying event that opens a special enrollment period for you to purchase your own health coverage. And youll have more options, flexibility and control of your health plan outside of COBRA with an individual health insurance plan.

So now you get to call the shots, and we can guide you along the way. We have plans of all shapes and sizes. Well help you find a plan that provides the health care you need within your budget.

Read Also: Can You Get Health Insurance

Proof Of Qualifying Life Events

If you are using a qualifying life event to add, drop or change healthcare coverage, you will be required to provide proof. The proof required will vary depending on the qualifying life event you have experienced.

For example, if you had a baby, you will need to provide a birth certificate and possibly a Social Security number. If your spouse died, leaving you without coverage, you will need to provide a death certificate. If you moved, you will need to provide proof of an address change.

Losing Individual Health Coverage For A Plan Or Policy You Bought Yourself

If you lose individual health coverage, you may qualify for a special enrollment period in the following circumstances:

  • Your insurance carrier stops offering your individual policy
  • You lose eligibility for a student health policy
  • You lose eligibility for a policy because you no longer live in the policys service area
  • Your individual or group health policys coverage year ends in the middle of the calendar year and you dont renew it

If you voluntarily drop coverage or lose your coverage because you didnt pay your premiums or provide required documentation to the exchange when prompted, you wont qualify for a special enrollment period.

Also Check: What Are The Different Types Of Health Insurance Plans

How A Qualifying Life Event Works

Health plan providers often allow you to make changes to your plan for 60 days after this type of event.

Contact your company as soon as you can to start this special process.

You may be asked to prove your eligibility for a special period, and for a copy of your denial letter if you’re trying to apply because Medicaid or CHIP turned you down. A judge’s order will be necessary if you gain a dependent through a court process.

These types of proof are required within 30 days of picking a plan in most cases. The insurer will send you notices about your status and any rules you haven’t yet met or proof that you haven’t yet sent in.

Lost My Health Insurance Including Medi

How to get Health Insurance Coverage Outside of Open ...

If youve lost or will soon lose Minimum Essential Coverage health insurance, you may qualify for special enrollment. In order to qualify, you must not have lost your coverage voluntarily. That means, for example, you do not qualify if your coverage was cancelled because you werent able to pay for it. However, if you had employer-sponsored coverage and lost your job, you probably lost your coverage as well. In this case you would qualify and may enroll in a plan. Consumers who have an involuntary loss of MEC will have a unique 120 day special enrollment period in which they can apply up to 60 days before and 60 days after the loss event date.

Another common example is someone who loses their Medi-Cal coverage. Perhaps youve been on Medi-Cal for a while, and then you receive a raise on your job or start working more hours. If your increased income pushes you above the threshold for Medi-Cal and its cancelled, you would qualify for special enrollment.

More examples:

COBRA coverage expires You dont qualify for student health coverage anymore You dont qualify for a family plan anymore because you turned 26 You dont qualify for a child-only plan anymore because you turned 19

Recommended Reading: Does Health Insurance Cover Breast Pumps

What Options Do I Have If We’re On Strike Or Lockout

Strike and lockout situations can be difficult to handle. Theres usually plenty of confusion and frustration to go around. Amidst the strain of it all, you may have lost your health insurance due to these changes at work. Or maybe your life has changed and youre now leaving the union and losing your health coverage.F75

No need to worry. Losing your job-based health insurance coverage may be a qualifying event that triggers a special enrollment period when you can find a private, individual health insurance plan.

We know that times are tough and thats why we have plan options for budgets big and small. Even if youre eligible to receive COBRA benefits, we can help you weigh all of your options from long-term to Short Term insurance plans.

Is Voluntary Loss Of Coverage A Qualifying Event

Luckily, as long as it wasnt voluntary, your loss of coverage is a qualifying life event, according to Covered California. This means you have sixty days from when you lost coverage to enroll in a new plan! Typically, in order to enroll it would have to be during an open enrollment period.

Recommended Reading: Is Ivf Covered By Health Insurance

What Is An Irs Qualifying Life Event

An IRS qualifying life event, or QLE, is a change in your circumstances that will require changes to their health insurance. A QLE allows you to make changes or purchase new health insurance policies outside the Open Enrollment Period. These time-periods help ensure you can maintain the coverage they need throughout the year.

Types Of Qualifying Life Events

COBRA Qualifying Events

Many of lifes big moments may open the door to making changes to your health insurance coverage outside of the regular open enrollment period. Changes can most often be made either 30 or 60 days after the qualifying life event happens. Heres a little about each event that might qualify.

If youve experienced a qualifying life event, please call the phone number on your member ID card.

Don’t Miss: How To Apply For Kaiser Health Insurance

Is A New Job A Qualifying Event

No, getting a new job is not considered a qualifying event for special enrollment. However, gaining new employment may trigger a special enrollment period for the group coverage at the new job, should the employer offer it. Picking up employer-based coverage will trigger a disenrollment period for other coverage.

What Is A Qualifying Life Event

A qualifying life event refers to a major change in your life that makes you eligible for a special enrollment period on the healthcare exchange website.

If you lose your health insurance coverage, including your employer-based plan, Medicaid, Medicare, COBRA insurance, or you are turning 26 and will lose your eligibility to stay on your parents health insurance plan, you will most likely qualify for a special enrollment period. If you lost coverage in the past 60 days or expect to lose it in the next 60, you should apply for a special enrollment period.

Changes to your household size that make you eligible include getting married, getting divorced, and a death in the family that results in a loss of coverage.

These changes must have happened in the past 60 days. If you had a baby or adopted or fostered a child, your new coverage will start the day of the event, even if you enroll 60 days later.

If you are moving, you will typically qualify for a special enrollment period. You must prove that you had health insurance for at least one of the 60 days prior to your move. Other qualifying events might include changes in your income, becoming a United States citizen, and several other events.

Don’t Miss: Can I Get Health Insurance Outside Of The Marketplace

Loss Of Health Insurance

If you or someone in your household loses or is expecting to lose health coverage in the next 60 days, you may qualify for a Special Enrollment Period. The health insurance policy youre about to lose must check one or more of the following boxes for you to be eligible for a Special Enrollment Period:

  • You no longer qualify as a dependent under your parent or guardians health insurance plan.
  • You or a family member, spouse, or parent has quit, been laid off, or fired from their job, resulting in a loss of health coverage through your employer or the employer of your family member, spouse, or parent. If you or your spouse starts a new job, youll most likely qualify for a Special Enrollment Period.
  • Youre losing Medicaid or Childrens Health Insurance Program coverage due to something like a change in your household income.
  • Youre no longer eligible for a student health plan.
  • Your current plan is being discontinued.

Note: Voluntary loss of coverage is not considered a qualifying life event.

Who Do You Contact

Whatâs considered a qualifying life event? You need health ...

If you work in a non-centralized agency, please contact your Agency Benefits Coordinator for assistance in making changes to your benefits. If you work in a centralized agency whose benefits are administered by the State Personnel Department Benefits Division, contact the Benefits Hotline at:

1-877-248-0007 toll-free outside the 317 area code

Read Also: How To Extend Health Insurance

What Are My Civilian Insurance Plan Options

Good news: If you lost your health coverage after returning from military service, this qualifying event opens a special enrollment period for you. In an effort to make your transition into post-military life smoother, let us help you find a health insurance plan that gives you the coverage you need.

Cover Your Needs For The Long Haul

Our insurance plan portfolio offers you a broad range of coverage, plan types, deductibles and supplements each with its own particular advantages. Our goal is to provide you with comprehensive and personal health plan choices that fit your needs and budget.

The advantages of your own health plan:

  • Fitted You can select a plan thats a good fit for your specific health concerns or tight budget.
  • Portable You can base your job decisions on your career goals, not the benefits offered.
  • Stable If your job changes, you keep your plan and any deductible youve paid.


Losing COBRA Benefits

COBRA expiring? Losing job-based health insurance for any reason means you may be eligible for health insurance during a Special Enrollment period.

Read Also: Does Health Insurance Cover Allergy Testing

What Is Considered A Qualifying Event For Health Insurance

During this 60 day window you can enroll in coverage and in some cases change existing coverage. A permanent move to an area where different health plans are available as long as you already had coverage prior to the move.

Aca Qualifying Life Events Student Health Insurance Students Health How To Plan

Other Cases That May Qualify You For A Special Enrollment Period

How To Qualify for SEP (Special Enrollment Period) ACA Health Insurance Plans.

While the above life events are a sure way to qualify for a special enrollment period, there are other special circumstances that may also allow you to sign up for a health insurance policy outside of the open enrollment period. Though these circumstances arent considered qualifying life events, they could open a special enrollment window for you.

Well list these more complicated cases and explain them in more detail below:

  • Experiencing an exceptional circumstance
  • Experiencing an enrollment or policy information display error
  • Previously having lived in a state that hasnt expanded Medicaid and you became newly eligible for help paying for an insurance plan because of an increase in household income or move
  • Being determined ineligible for Medicaid or CHIP
  • Gaining or becoming a dependent due to a child-support or other court order
  • Experiencing domestic abuse or violence or spousal abandonment
  • Getting an appeal decision thats in your favor

Also Check: What Is The Largest Health Insurance Company

Popular Articles

explore more