A qualifying event for insurance is a change in life circumstances that makes a person eligible to enroll in health insurance outside of the annual open enrollment period.

Marriage, divorce, and becoming a parent are all common examples of major events that affect a person's health insurance needs. In these circumstances, a person becomes immediately eligible to purchase or change a health plan.

Depending on your plan, a qualifying life event gives you 30 days (sometimes 60 days) to make plan changes or sign up for new coverage.

4 types of qualifying life events

Loss of health insurance

Loss of health insurance coverage is a QLE. It can happen if you:

• Losing coverage under parents' insurance plan when you turn 26
• Losing job-based coverage, COBRA, or student plan
• Losing eligibility for Medicare, Medicaid, or the Children’s Health Insurance Program (CHIP)
• Losing health insurance for any reason other than non-payment of premiums

Changes in the home

There are certain household changes that will trigger a QLE, such as:

• being married, separated, or divorced
• having a child, adopting a child, or getting a foster child
• Experiencing the death of someone on your health insurance policy

Change of residence

You may be eligible for QLE when you change your place of residence. For example:

• Moving to a different county or zip code
• For students, while going to and coming from school
• For seasonal workers, traveling to or from a work location
• moving into or out of a shelter or temporary accommodation
• Moving to the US from a US territory or foreign country

Changes to your eligibility

In addition to the examples above, there are some additional circumstances that are considered qualifying life events, including:

• Changes in income that affect your eligibility for Medicaid coverage
• Becoming eligible for premium-reducing tax credits after already having an ACA plan
• Becoming a member of a federally recognized tribe
• Becoming eligible for Marketplace coverage for new US citizens
• For AmeriCorps Vista members, the beginning or end of service
• being discharged from the army
• Release from captivity

Examples of Special Enrollment Periods

There are times when an  extraordinary circumstance  (also called a special circumstance) arises that may make someone eligible for a Special Enrollment Period.

Examples of events that qualify for special enrollment include:

• Being barred from enrolling during open enrollment due to a serious medical condition or natural disaster (such as a pandemic or hurricane)
• If any person holding a government post has obstructed the nomination, made a mistake in the nomination, given wrong information etc.
• If a technical error occurred or incorrect policy data was displayed on Exchange
• Applying for Medicaid or CHIP during open enrollment but being deemed ineligible after open enrollment ends
• Acquiring a new dependent or becoming dependent on someone else due to a court order
• Enrolling in a new individual health policy if you are a victim of domestic abuse or abandonment by your spouse
• Filing and winning an appeal after an incorrect eligibility determination or substantial breach of contract

How much time do you have for a qualifying event?

Special enrollment periods typically last 30–60 days before or after a qualifying event, during which an individual is allowed to make plan changes or immediately enroll in a new health insurance plan.

There are three dates you should check with your plan before you assume you're covered:

• The date your eligibility was confirmed
• The date your coverage begins
• The date of your first premium payment

What qualifying life event documents do you need to provide?

When it comes time to purchase a new plan or make changes to an existing plan, there are certain qualifying life event documents you may need to submit in order to become eligible. The documents must be submitted within 30 or 60 days (depending on the plan) and each document must be signed and dated. When documentation is difficult to provide, an affidavit is usually sufficient.

Different qualifying life events require specific documentation:

• Parent's plan expires:  Proof of prior coverage within the last 60 days
• Becoming a parent:  birth certificate or adoption record
• Death:  Death Certificate
• Getting married:  marriage certificate
• Getting a divorce:  filing papers with the court
• Government Enrolment Error:  Signed Affidavit
• Job Loss:  Termination Letter
• Military discharge:  certificate of release
• Transfer:  Proof of residence from new and old address
• US Citizenship:  Certificate of Naturalization

Is getting pregnant an important event in life?

No  , being pregnant is not a qualifying life event for a special enrollment period in the marketplace. However, giving birth, adopting a child, or placing a foster child in your home are qualifying life events.

Is getting a new job a qualifying event?

No  , getting a new job is not considered a qualifying event for special enrollment. However, getting a new job may trigger a special enrollment period for group coverage at the new job, if the employer offers it. Taking employer-sponsored coverage will trigger a disenrollment period for other coverage.

Is changing jobs a meritorious event in life?

No,  changing jobs within an organization is not a qualifying life event. Your employer-based coverage will remain the same unless you have the opportunity to make a change during the open enrollment period.

Is your spouse getting a new job a significant event in life?

No, if  your spouse gets a new job it is not considered a qualified life event if the change does not cause any loss of insurance to you or your spouse.

Is a vacation a qualifying life event?

Yes, under certain circumstances.  If the leave causes you to lose eligibility or your employer to drop coverage, the leave is  considered a qualified life event.  However, if your employer increases eligibility and coverage during the leave, it is not eligible.

Is spouse leaving job a significant event in life?

Yes, under certain circumstances.  If your spouse's employer was providing insurance coverage to you and your spouse, your spouse leaving or quitting the job for any reason would be considered a qualifying life event, as your coverage would then end.