There is a specific time each year that insurance plans allow you to enroll in health insurance, and this is called Open Enrollment health insurance. If you’re unable to sign up during this time, The Affordable Care Act (ACA or “Obamacare”) allows you and your family to sign up for health insurance outside of Obamacare’s open enrollment period if you experience certain qualifying life events.

Such qualifying life events include marriage, childbirth, and other major happenings. In most cases, you have 60 days after the date that triggered the qualifying life event to purchase major medical individual or family health insurance coverage. This 60-day period is sometimes referred to as your special enrollment period.

Here is a complete overview of what qualifying life events are so you can better understand what an insurance qualifying event is.

What are Qualifying Life Events (QLEs)?

Qualifying Life Events (QLEs) are significant changes in your life that allow you to enroll in or change your health insurance outside of the usual open enrollment period. These events include major transitions such as getting married, having a baby, or losing other health coverage due to job loss. Other examples include moving to a new area that offers different health insurance options, or significant changes in your income that affect your coverage eligibility. Each of these events opens a special enrollment period, typically lasting 60 days from the date of the event, during which you can adjust your health insurance to better fit your new circumstances. This system ensures that during major life changes, you and your family can maintain continuous and appropriate health coverage without waiting for the annual enrollment period.

Types of Qualifying Life Events

Here are some examples of qualifying events that would enable you to enroll in a new health insurance plan, regardless of the time of year.

Loss of health care coverage

If you have lost your health care coverage as a result of losing your job or no longer qualifying for state health insurance, then, as long as you can prove it, you will be allowed to take advantage of a special enrollment period.

Death of a family member

If a family member passes away, then this event allows you to make changes to your current plan or even sign up for a new plan. Instead of paying for a family plan, you might decide to sign up for an individual health insurance plan, which could also save you money.

You get a new dependent

Whether you adopt a child, give birth to a new baby, or get married, these events are classified as a qualifying life event, as you have gained a new dependent. As a result of this event, you can modify your current insurance plan to include your new family member, or you can opt to completely change plans.

Changes in the household

Changes in your household that would allow you to be able to make changes to your health insurance coverage or apply for a new plan include separation, divorce, or marriage. Most insurance plans will request proof of the household change for you to qualify for the special enrollment period.

Change in citizenship status

A change in your citizenship status is considered a qualifying life event, allowing you to obtain insurance during a special enrollment period. Insurance rules vary for citizens and non-citizens, so be sure to report any citizenship changes.

Government error

If a government error is discovered, then depending on the specific error, you might qualify to enroll in health insurance, as this could be one of many qualifying events for health insurance.

Change in subsidy eligibility

Whenever your income, number of family members or another factor that pertains to your Marketplace subsidy changes, you will qualify for a special enrollment period. It is imperative that you report all changes in your situation to Marketplace employees to ensure you don’t pay more than necessary or have to repay money because of your change.

Move to a new state or area

Insurance by state varies, as each state has its own specific rules and guidelines. This is why it’s important that you notify your health insurance plan if you move to a new state or area, but you will likely qualify for special enrollment.

You’ve turned 26

If you’ve recently turned 26 and you’re no longer eligible to be covered by your parents’ insurance, then this is another qualifying life event, and you will definitely qualify for a special enrollment period.

Changes in employment

A number of possible employment changes enable you to qualify for a special enrollment period. If your employment status changes from full-time to part-time, then you will qualify. You would also qualify if you were laid off, fired, or if you quit.

How to report a Qualifying Life Event

Reporting a Qualifying Life Event (QLE) on the Health Insurance Marketplace is an important step to ensure your coverage needs are met without interruption. Here’s how you can report a QLE:

1. Steps to Report a QLE on the Health Insurance Marketplace:

• Log in to your account: Start by logging into your existing account on the Health Insurance Marketplace website.
• Report changes: Navigate to the section where you can report changes in your circumstances. This might be labeled something like “Report a life change” or similar.
• Enter details of the QLE: You’ll need to provide specific information about the life event, including the date of the event and details of how it changes your coverage needs.

2. Documentation Requirements:

• Proof of the event: You will generally need to provide documentation that proves the life event occurred. This could include a marriage certificate, birth certificate, proof of address change, or a letter from your previous employer about health coverage termination.
• Submit documents: You may be able to upload these documents directly through the Marketplace website or, in some cases, mail them to the designated address.

3. Timeframes for Reporting QLEs:

• 60-day window: You typically have 60 days from the date of the QLE to report the event and change your health plan. It’s crucial to act within this period to avoid any gaps in your coverage.
• Immediate effect: Once reported, changes can take effect quickly, often starting the first day of the month after you report the event and choose a new plan.

It’s important to keep all relevant documents readily available and to act swiftly once a qualifying life event occurs. This ensures that your health insurance coverage can be adjusted to fit your new needs without any delay.

FAQs about QLEs and the Special Enrollment Period (SEP)

What are some things I should I know about my Special Enrollment Period?

It is easy to determine if you qualify for a special enrollment period. Keep in mind that you have 60 days from the qualifying event to make changes to an existing policy or sign up for one of the many health insurance plans.

Experiencing any of the qualifying life events listed above may allow you to purchase health insurance coverage on your own outside of open enrollment.

You will likely be required to show proof of your qualifying event.

What happens if I miss the SEP window?

Missing the Special Enrollment Period (SEP) window after a Qualifying Life Event (QLE) can leave you without the option to change or enroll in a health insurance plan until the next Open Enrollment Period. This means you could be without health insurance coverage for several months, potentially facing high medical costs if you need care during that time. It’s crucial to act quickly after a QLE occurs—typically within 60 days—to ensure you maintain continuous coverage or can make necessary adjustments to your existing plan.

Can I apply for SEP if I know a QLE is coming?

 You cannot officially apply for a Special Enrollment Period until the Qualifying Life Event actually occurs. However, knowing an event is coming, such as a planned marriage or a baby’s due date, allows you to prepare and gather necessary documents in advance. Once the event happens, you can immediately proceed with your application, which can help streamline the process and ensure that your new coverage can start as soon as possible after the event.

How long does it take for coverage to start after a QLE?

The start date of your coverage after reporting a QLE depends on the type of event and when you enroll. Generally, if you enroll before the 15th of the month, your new coverage begins on the first day of the following month. If you enroll after the 15th, the coverage will typically start on the first day of the second month. For certain events like the birth of a child or marriage, coverage can start from the day of the event if you enroll by the last day of the month in which the QLE occurred. Promptly enrolling after your QLE ensures the earliest possible start date for your new coverage.

Get the most out of Your Special Enrollment Period with eHealth

If you find yourself without adequate health insurance coverage and you’re unable to obtain open enrollment health insurance, then you shouldn’t simply go without it. There may be a health insurance qualifying event that will allow you to sign up for a health insurance plan outside the normal open enrollment period. If you’re confused about the whole process and you don’t know where to begin, let eHealth help you. We have resources that let you compare health insurance companies and more to help you find the coverage you need. You can learn about HMO plans, PPO plans, and so much more, which can be helpful in finding the perfect health insurance plan.