A Guide to Understanding Qualifying Life Events and Special Enrollment

Life happens, and when it does, it is very likely that your health insurance coverage may need to change. When you encounter a qualifying life event (QLE) outside of the open enrollment period that impacts your insurance needs, it is important to know that you may be able to take advantage of a special enrollment period. (Typically, you only have 60 days from the QLE to enroll in a new plan.)

Below are 7 situations considered a qualifying life event.


1) LOSS OF COVERAGE

You lost coverage due to:
– Termination of group coverage
– Reduction of hours to part time status
– Loss of employer contribution
– Cobra ending

Required proof:
Letter from employer, Certificate of credible coverage

 

2) MARITAL STATUS CHANGE

You lost coverage due to:
– Marriage
– Divorce
– Legal separation

Required proof:
Marriage Certificate or divorce/separation court documents, Certificate of credible coverage

 

3) DEPENDENT STATUS CHANGE

You lost coverage due to:
– Birth of a child
– Adoption
– Aged out of dependent status

Required proof:
Child’s DOB, Legal adoption paperwork, Certificate of credible coverage

 

4) MOVING

You lost coverage due to a permanent move to another state, or because you no longer live in your previous plan’s service area.

Required proof:
New Mortgage Bill/Renter’s Agreement and drivers license, utility, Postal Service change of address receipt

 

5) DEATH

You lost coverage due to your primary policy holder passing away.

Required proof:
Death Certificate, Copy of termination letter from prior insurance company

 

6) INCOME CHANGE

Your income changed and made you newly eligible (or ineligible) for a tax credit.

Required proof:
Copy of certificate of creditable coverage OR a copy of the termination letter from prior Insurance Company and/or federal or state agency

 

7) NON-CALENDAR YEAR

Your current plan ends on a non-calendar year basis.

Required proof:
Copy of termination letter from prior insurance company OR Certificate of Credible Coverage


If you still need coverage and none of these apply to you, we may have other solutions for you such as Short Term Medical. Short Term health insurance plans are designed to provide temporary health care insurance during unexpected coverage gaps. With a Short Term Medical policy, you choose how the coverage fits your needs or the needs of your family. To learn more about this solution, call (800) 282-8626.