What Is a Qualifying Life Event?

Definition & Examples of a Qualifying Life Event

A couple with an infant is at home. The man is kissing the baby on the cheek.
••• Geber86 / Getty Images

A qualifying life event is a change in your situation that provides you with a special enrollment period for health insurance.

Learn more about which situations are qualifying life events.

What Is a Qualifying Life Event?

Every year during open enrollment, you can enroll in and make changes to health insurance. You can also shop for and make changes to health insurance outside of the open enrollment period if you have a qualifying life event. These events include marriage, having a child, and divorce. After one of these events, you have a special enrollment period, during which you can make changes to your health insurance plan.

  • Acronym: QLE

How a Qualifying Life Event Works

Health insurance providers typically allow you to make changes to your insurance for 60 days after a qualifying life event. Contact your insurance company as soon as possible after your life event to start the special enrollment process.

You may be asked to prove your eligibility for a special enrollment period. For example, if you are applying for special enrollment due to a denial of coverage by Medicaid or CHIP, you may be asked for a copy of your denial letter. If you gain a dependant via a court order, you'll need to provide a copy of that order.

If asked to prove eligibility, you'll typically need to provide that proof within 30 days of plan selection. You'll receive notices regarding the status of your special enrollment applications and outstanding requirements.

Examples of a Qualifying Life Event

Qualifying life events revolve around changes in job, location, income, or family status. For example, a change in family status or household size qualifies. This could include marriage, separation, gaining a dependent, losing a family member, and court-ordered family dependent changes.

Changing where you live could also qualify. This change could include moving to a new state or moving when you're a student.

Loss of health insurance also qualifies. This event can be either 60 days in the past or 60 days into the future.

Non-Qualifying Life Events

A qualifying life event is a life-changing circumstance that impacts your health insurance. If you have a situation that seems like a qualifying life event but doesn't alter your health plan benefits, it may not qualify.

For example, a divorce or loss of a family member, without any resulting change in insurance coverage doesn't entitle you to a special enrollment period. Other non-qualifying events include:

Complex Issues

There are unique situations that may qualify you for a special enrollment period, even if they don't involve a change in family size, location, or employment. For example, experiencing domestic abuse or violence or you faced a serious medical condition or natural disaster during an enrollment period and were unable to enroll. These cases are termed complex issues and are reviewed on a case by case basis.

Alternatives to a Qualifying Life Event

If you don't qualify for a special enrollment, you can look into applying for Medicaid or the Children's Health Insurance Program (CHIP), which always accepts applications.

If you don't qualify for those, consider looking into membership health insurance or temporary health insurance. Membership health insurance is health insurance you obtain by belonging to an organization. For example, members of the Writers Guild of America are entitled to health coverage.

Temporary or short-term health insurance does help in the event of a catastrophic event, but it isn't a good long-term option, since coverage tends to be minimal.

You can also wait until the next open enrollment period, which is typically at the end of the year with coverage starting on January 1.

If you need health insurance and are enrolled in a higher education program, see if your school offers a student health plan.

Key Takeaways

  • A qualifying life event is a change in your situation that provides you with a special enrollment period for health insurance.
  • You can typically make changes to your insurance, like adding or disenrolling a spouse or dependent, when you have a qualifying life event. 
  • Health insurance providers typically allow you to make changes to your insurance for 60 days after a qualifying life event. 
  • Qualifying life events revolve around changes in job, location, income, or family status.
  • If you don't qualify for a special enrollment period, you can look into Medicaid, CHIP, member health insurance, or temporary health insurance. 

Article Sources

  1. HealthCare.gov. "Enroll in or Change 2020 Plans—Only With a Special Enrollment Period." Accessed Aug. 9, 2020.

  2. HealthCare.gov. "Special Enrollment Periods for Complex Issues." Accessed Aug. 9, 2020.