What is a Qualifying Life Event?
A qualifying life event, also called a QLE, is a change in your life, either planned or unplanned, that has an impact on your insurance coverage. These events are especially important when it comes to enrolling in an insurance plan outside of the open enrollment period.
How do qualifying life events work?
During open enrollment, you can enroll in health insurance, dental insurance, and other insurance benefits through your employee benefits package or the healthcare marketplace.
Signing up for insurance outside of this period typically requires you to have undergone a qualifying life event. When that happens, you enter what’s called a special enrollment period, and you’re eligible to sign up for insurance even though it isn’t the designated time for open enrollment.
Qualifying life events can be stressful or welcome. Either way, they represent a chance to adjust your coverage.
Examples of qualifying events for insurance
There are a number of circumstances that can allow you to enroll in insurance outside of the open enrollment window. Most major changes in your life will qualify—below you’ll find the most common scenarios.
- A change in your legal relationship status
- e.g., marriage, divorce, or separation
- Having a baby or adopting a child
- Sudden loss of coverage
- Turning 26 and aging out of your parents’ insurance
- Change in job status, like a new job or loss of a job
- The death of the named party on multi-person insurance policies
- Losing eligibility for Medicare, Medicaid, or Children’s Health Insurance Program (CHIP
- Moving to a new ZIP code or country
- Becoming a citizen
- Turning 65 and becoming eligible for Medicare
- Being released from incarceration
- Becoming a member of a federally recognized tribe
Each of these circumstances could qualify you for a special enrollment period but will likely need to be proven to the insurance company in order for you to enroll in a policy or change your coverage. You can typically provide proof of a qualifying life event by submitting documentation (for example, a written job offer or citizenship papers). Approved kinds of proof vary based on the event you’ve experienced.
What to do if you experience a qualifying life event
When you face a qualifying life event, you’ll need to make changes to your insurance coverage within a specific time frame—usually 30 or 60 days before or after the event. After that window, you won’t be able to change your coverage until the next open enrollment period (or another qualifying life event).
If and when you do experience one of these events, you should reference your plan information documents and contact either your employer or your insurance company to begin the process of updating your plan.
What if I need to enroll in a plan outside of open enrollment, but don’t qualify?
If you find yourself in need of coverage outside of open enrollment, but you don’t qualify for the special enrollment period, there are still options available to you. First, you can appeal a decision and request a re-evaluation of your circumstance. Additionally, you can explore other options for obtaining coverage in a pinch, including:
Qualifying life events give you the chance to adapt when change happens
Life can come at you fast. Jobs and relationships can shift. But knowing you’ll be covered as you experience a major change can bring comfort and security during an unpredictable time. Qualifying life events and special enrollment periods enable you to select the right insurance for your circumstances, without waiting for your next open enrollment period.