A qualifying event is a change in life circumstances that allows you to alter an existing health insurance policy or sign up for a new one outside of open enrollment periods. Without a qualifying event, you would need to wait until the next open enrollment period before making any changes. Qualifying life events (QLEs) trigger special enrollment periods in all ACA-compliant major medical plans, including individual market, small group, and large group insurance plans. These types of policies have to allow you or your family member to enroll or make a plan change due to a qualifying event, assuming you meet all other eligibility requirements. Qualifying events also apply to plans that are semi-compliant with the ACA (grandfathered and grandmothered plans) . Certain qualifying events also trigger special enrollment periods for Medicare coverage.
Examples of qualifying life events include:
- Loss of health coverage, including job-based, individual, and student plans
- Losing eligibility for Medicare, Medicaid, or CHIP
- Turning 26 and losing coverage through a parent’s plan
- Getting married or divorced
- Having a baby or adopting a child
- Death in the family
- Moving to a new area
- Earning U.S. citizenship
- Turning 65
- Experiencing a shift in employment status
- Loss of health insurance
- Significant change in costs of health or day care
When you experience a qualifying life event, you typically have up to 60 days to make changes to your health insurance plan. To determine your eligibility for a qualifying life event, notify your health insurance provider as soon as these circumstances happen. You may need to provide documentation to prove that you have experienced a qualifying event.
