What is a Qualifying Life Event?
In the U.S., a qualifying life event for health insurance refers to a major change in an individual’s situation that qualifies them to enrol in health insurance outside of the constraints of the yearly Open Enrolment Period.
Generally, Special Enrolment lasts 60 days before or after the qualifying life event takes place and enables the individual to immediately make plan changes or sign up for a new coverage.
The four categories of Qualifying Life Events
1. Loss of Health Insurance
- An individual turns 26 and loses coverage through a parent’s insurance plan
- Losing a job-based coverage, COBRA, or a student plan
- Not passing the eligibility for Medicare, medicaid, or the Children’s Health Insurance Program (CHIP)
- Losing health insurance for any reason other than not paying the premiums
2. Change in household
- Getting married, separated, or divorced
- Having a baby, adopting a child, or receiving a foster child
- The death of a dependent on an individual’s health insurance policy
3. Changes in residence
- Moving to a different city
- For student, moving to or from school
- For seasonal workers, moving to or from a work location
- Moving in or out of a shelter or transitional housing
- Moving to the U.S. from a U.S. territory or foreign country
4. Other qualifying changes
- Changes in income that affect an individual’s eligibility for Medicaid coverage
- After already having an ACA plan, an individual becomes eligible for tax credits that lower premiums
- Becoming a member of a federally recognized tribe
- New U.S. citizens become eligible for marketplace coverage
- For AmeriCorps VISTA members, beginning or ending service
- Being released for incarceration
FAQs
Is pregnancy a qualifying life event?
Yes, pregnancy is generally considered a qualifying life event for health insurance enrollment in the United States. When a person becomes pregnant, it qualifies as a change in their situation that allows them to enroll in or make changes to their health insurance coverage outside of the regular Open Enrollment Period. This typically falls under the category of a "change in household" or a similar qualifying event, which allows individuals to adjust their health insurance plans to accommodate the upcoming birth and related medical needs.
What is a qualifying life event (QLE) in the context of health insurance?
A qualifying life event refers to a significant change in an individual's circumstances that allows them to enroll in or make changes to their health insurance coverage outside of the regular Open Enrollment Period.
Can I enroll in a different health insurance plan during a Special Enrollment Period (SEP)?
Yes, if you experience a qualifying life event, you can usually choose to enroll in a different health insurance plan that better meets your needs.
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