When life changes, sometimes your insurance coverage needs to change with it. But what do you do if these changes happen outside of the regular open enrollment period? If your life change is considered a qualifying life event (QLE), you may be able to update your insurance during a special enrollment period.
Read on to learn how qualifying life events for insurance work, see some examples and find out what you need to do to update your insurance.
What is considered a qualifying life event?
A qualifying life event is a change in your life, either planned or unplanned, that has an impact on your insurance coverage. There are four main types of events: changes in your household, changes in your residence, loss of coverage, and those defined as other qualifying life events.1 QLEs are especially important when it comes to enrolling in or changing an insurance plan outside of open enrollment.
How do qualifying life events work?
During open enrollment, you can enroll in or change your health insurance, dental insurance, and other insurance benefits through your employee benefits package or the healthcare marketplace.
Signing up for or updating your insurance outside of this period typically requires you to have undergone a QLE. When that happens, you enter what’s called a special enrollment period (SEP), meaning you’re eligible to sign up for insurance — or modify your current insurance elections — even though it’s not the designated time for open enrollment.2 QLEs can be stressful or welcome. Either way, they represent a change that requires adjusting 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 are some of the most common scenarios.
- A change in your legal relationship status
- Having a baby or adopting a child
- A 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 the Children’s Health Insurance Program (CHIP)
- Moving to a new ZIP code or country
- Becoming a U.S. citizen
- Turning 65 and becoming eligible for Medicare
- Being released from incarceration
- Becoming a member of a federally recognized tribe
While this isn’t an exhaustive list, each of these circumstances could qualify you for a special enrollment period. However, the QLE will likely need to be proven to the insurance provider — typically by providing supporting documentation of the life-changing event — in order for you to enroll in a policy or change your coverage.
What documents do you need to verify a QLE?
Approved documents to verify a QLE vary based on the event you’ve experienced. You may need a marriage license, divorce papers, birth certificate, adoption papers, or death certificate to show you had a change in the household. A written job offer or new rental or mortgage contracts might be used to prove a change in residence if you moved to a new area. Other documents you might need to verify a QLE could include citizenship papers, incarceration release papers, official notices showing you lost previous health insurance coverage or eligibility, tribal membership papers, and more.
Talk with your insurance provider to learn exactly what documents you need if you believe you qualify for a SEP.