Qualifying Life Events in Health Insurance
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Some life events compel you to change your health insurance plan outside the enrollment open period. Some people are not aware of the fact, but you get more benefits after taking advantage of the exception. The special enrollment period enables you to make adjustments to your insurance plan when the changes in life are qualifying life events. What do you need to know about qualifying life events in health insurance?
Which events stand as qualifying events in health insurance?
Qualifying life events occupy 4 categories: health coverage loss, household changes, residence changes, and other related qualifying events. Regarding health coverage loss, losing an existing coverage, such as student, individual, and job-based plans, qualifies you to enroll for a health plan outside the open period.
Sometimes you can also experience household changes that include marriage or divorce, birth or adoption of a child, or death of a family member. The changes allow you to change your health plan outside the open enrollment period.
Qualifying events due to residence changes include change of a ZIP code or county. Additionally, change of schooling location, moving shelters due to transitional housing policy, and change of a seasonal workplace are also some of the qualifying events under the category.
Regarding the other related qualifying events, income adjustments that affect coverage qualification and becoming a member of a federally recognized status, such as a native tribe, stand as some of the qualifying events. Additionally, becoming a U.S. citizen, incarceration, and starting or ending service as an AmeriCorps member are also some of the qualifying life events.
Which events do not make up the qualifying life events in health insurance?
Some life changes are not qualifying life events. For example, if divorce or death does not have any effects on the existing insurance coverage, then the event is not part of qualifying events. A change of residence when you take a vacation, voluntary termination of an existing cover, and cancellation of a cover due to non-payment do not also form part of qualifying events.
The argument behind the non-qualifying events is that they do not affect the benefits of your existing health plan. The events also do not give rise to any actual change in your situation in life.
What are the qualifications for a special enrollment period?
You need proof to qualify for a special enrollment period. For example, if you gain a dependent via a court order, then you have to attach a copy of the court order to the application form. You have to provide the proof within 30 days. Afterward, you will get a notice of the status of your application or a request for additional requirements.
Qualification for a special enrollment period can also occur due to complex circumstances. Some of the examples of the complex issues include open enrollment error, movement from a state that did not support Medicaid to one that supports the plan, domestic violence, spouse abandonment, child support due to a court order, a court appeal to your favor, among others.
In an instance when you do not qualify for a special enrollment period, you should explore other available options. The first option is to make a fresh application for Medicaid or CHIP (Children's Health Insurance Program). You can also opt for a membership health cover or a temporary cover. The move will help you to get a health cover before the open enrollment period starts.
Does age determine eligibility for a qualifying life event?
Age is a determining factor in the eligibility for a qualifying event. According to the Affordable Care Act, you should apply for your own insurance cover after turning 26. You only have 60 days to enroll in a health insurance plan after turning 26. Enrolling before turning 26 enables your coverage to commence on the first day after turning 26 while enrolling during the 60 days makes the coverage to start on the first day after collection of the coverage. After enrolling successfully, then you become eligible for a qualifying life event.
Can one change medical plans during a qualifying event?
Medicare and Medicaid are part of the health care programs. Both are medical plans that support qualifying events since they are health insurance covers under the Affordable Care Act. Therefore, it is possible for you to change your medical plans during a qualifying event.
How long should one wait before enrolling after a qualifying event occurs?
The best time to change health plans is when you are experiencing a qualifying life event. You do not wait until the event comes to a conclusion. Additionally, some qualifying events have obvious outcomes and you do not have to wait until they come to an end. Prudence dictates that you should act before the time when applying for coverage when the events qualify outright.
In conclusion, you have 30 days to make a qualifying life event change to health insurance following the special enrollment steps. All you need to do is to make an online enrollment to the Health and Welfare Benefits, choose the most appropriate event that matches your situation, and provide supporting documents. The documents should feature the effective date of the qualifying event; gains and losses of coverage, and individuals that suffered the loss or achieved the gains. You can also submit your queries when in doubt about the requirements.