Qualifying Events for Insurance

When it comes to getting health insurance, there are certain times of the year when you can enroll or make changes to your plan. These are known as open enrollment periods. However, under certain circumstances, you may qualify for a special enrollment period, which allows you to enroll outside of open enrollment. These are called qualifying events. In this article, we will explore qualifying events for insurance, so you can determine if you are eligible for a special enrollment period.

What is a Qualifying Event?

A qualifying event is a life event that allows you to enroll in or make changes to your health insurance plan outside of the normal open enrollment period. These events include:

Event
Description
Loss of health coverage
If you lose your health insurance coverage due to job loss, aging out of a parent’s plan, divorce, or other reasons, you may qualify for a special enrollment period.
Marriage or domestic partnership
If you get married or enter into a domestic partnership, you may qualify for a special enrollment period.
Birth or adoption of a child
If you have a child through birth or adoption, you may qualify for a special enrollment period to add them to your insurance plan.
Permanent move
If you move to a new area where your current health plan is not available, you may qualify for a special enrollment period.
A change in income or household status
If you experience a change in income or household status, such as getting married or divorced, having a child, or gaining or losing a dependent, you may qualify for a special enrollment period.

How to Qualify for a Special Enrollment Period

If you experience a qualifying event, you will need to provide proof of the event and apply for a special enrollment period. To qualify, you must:

  • Experience a qualifying event
  • Provide proof of the event
  • Apply for coverage within 60 days of the event

It is important to note that some qualifying events are specific to certain types of insurance plans, such as employer-sponsored plans or Medicaid. Be sure to check the specific requirements for your plan.

Frequently Asked Questions

What if I miss the 60-day window to enroll?

If you miss the 60-day window to enroll in a new plan, you will have to wait until the next open enrollment period to make changes to your coverage. However, if you experience another qualifying event, you may be eligible for another special enrollment period.

What if my spouse loses their job and health coverage?

If your spouse loses their job and health coverage, you may be eligible for a special enrollment period to add them to your plan. You will need to provide proof of their job loss and apply for coverage within 60 days of the event.

What if I move but my current plan is still available?

If you move but your current health plan is still available, you may not be eligible for a special enrollment period. However, if you move to a new area where your plan is not available, you may qualify.

Can I change my plan during a special enrollment period?

Yes, you can change your plan during a special enrollment period. You can choose to enroll in a new plan or make changes to your existing plan.

What if I experience a qualifying event outside of the open enrollment period?

If you experience a qualifying event outside of the open enrollment period, you may be eligible for a special enrollment period. Be sure to check with your insurance provider to see if you qualify.

Conclusion

If you experience a qualifying event, it is important to understand your options for enrolling or making changes to your health insurance plan. By knowing what qualifies as a qualifying event, and what steps you need to take to apply for a special enrollment period, you can ensure that you have the health coverage you need.