What Is a Qualifying Life Event?

how a qualifying life event works

The Balance / Julie Bang

DEFINITION

A qualifying life event is a change that provides you with a special period to enroll for health insurance.

Definition and Examples of Qualifying Life Events

You can sign up for and make changes to your health plan every year during open enrollment. You can also shop for a health plan outside of that window of time—but only if you have a qualifying life event.

These events can include getting married, divorced, or having a child. You have a special time during which you can make changes to your health plan after one of these events.

  • Acronym: QLE

How Qualifying Life Events Work

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

Note

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.

Types of Qualifying Life Events

Qualifying life events revolve around changes in your job, location, income, or family status. A change in household size qualifies. This could occur due to marriage, separation, gaining a dependent, loss of a family member, and family changes ordered by a court.

Changing where you live could also qualify. That could include moving to a new state or moving because you're a student.

Loss of your old health plan also qualifies, 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 plan. A change might not qualify if it doesn't affect your plan. A divorce or the loss of a family member won't get you a special enrollment period if it doesn't change your plan's coverage in any way.

Other events that don't count include moving just for a short time, voluntarily dropping your current health plan, or having your plan canceled for non-payment.

More Complex Issues

Some changes may qualify you for a special period, even if they don't involve a change in family size, location, or your job. You may have endured domestic abuse or violence or faced a medical condition or natural disaster during an enrollment period, making you unable to enroll.

Note

These cases are referred to as "complex issues." They're reviewed on a case-by-case basis.

Alternatives to Qualifying Life Events

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 special enrollment. You might also look into membership health insurance or a temporary health plan. Membership health insurance can be obtained if you belong to an organization that provides it. If you're a student, see whether your school offers a student health plan if you're enrolled in a higher education program.

A short-term health plan can help in the event of a catastrophic event, but it might not be a good long-term option, because coverage is often just minimal.

Key Takeaways

  • Qualifying life events are changes that provide you with a special enrollment period for health insurance; they revolve around changes in job, location, income, or family status.
  • You can make changes to your health plan, like adding or deleting a spouse or dependent, when you have a qualifying life event. 
  • Health plans will often allow you to make changes to your coverage for 60 days after this type of event. 
  • You can look into Medicaid, CHIP, a member health plan, or short-term health insurance if you don't meet the rules for a special enrollment period.

Article Sources

  1. Healthcare.gov. "Enroll in or Change 2021 Plans—Only With a Special Enrollment Period." Accessed Nov. 24, 2021.

  2. Healthcare.gov. "Special Enrollment Periods for Complex Issues." Accessed Nov. 24, 2021.