What Is a Qualifying Life Event For Insurance? 

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
  • Marriage, divorce, or separation
• 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.

What to do if you experience a qualifying life event

When you face a qualifying life event, you need to make changes to your insurance coverage within a specific time — usually 30 or 60 days before or after the event — depending on the type of SEP.² After that window, you likely won’t be able to change your coverage until the next open enrollment period or another QLE.

If and when you experience one of these events, reference your plan information documents and contact either your employer or your insurance company. It’s important to notify your employer of a QLE as soon as possible so you can begin the process of updating your plan. For example, if you’re having a baby, making sure you have updated coverage for associated hospital bills can save you time, money, and stress after giving birth. It also allows you to focus on caring for your newborn instead of figuring out finances for expensive bills.

What if something prevented you from securing coverage during open enrollment?

There are some complex situations, which fall outside of the general types of QLEs, where you may still qualify for a SEP.³ For example, if during open enrollment there was a natural disaster, you became temporarily cognitively impaired, technical errors occurred, or you applied for certain coverage but were told by the state that you’re ineligible after the enrollment period ended, you may be granted a SEP.

Contact your insurance plan provider to see if your complex situation qualifies you for a SEP.

What if you need coverage outside of open enrollment but don’t qualify for a SEP?

If you find yourself in need of coverage outside of open enrollment, but you don’t qualify for a special enrollment period, there are still options available. If you were denied a SEP, you can appeal the decision with your insurance provider and request a reevaluation of your circumstance. Additionally, you can explore other options for obtaining coverage in a pinch (if you are eligible), including:

• Medicaid
• COBRA insurance plans
• Short-term insurance plans

QLEs give you the chance to adapt when change happens

Changes in life can come fast. But knowing you have the opportunity to update your coverage after you experience a major life change can bring comfort and security during an unpredictable time. QLEs and SEPs enable you to select the right insurance for your circumstances, without needing to wait for the next open enrollment period.