What Is Considered a Qualifying Event for Health Insurance?

“Qualifying event” is a term we hear a lot, but it’s not always clear what it means. Below, we explain how qualifying events for health insurance work and how they affect you.  

What Is a Health Insurance “Qualifying Event”?

A qualifying event is a change in your life circumstances. Not every life event is a “qualifying” event, though – it must be a change which is significant enough to possibly affect your health insurance coverage. For example, maybe you’re adding new family members, moving to a new state, or switching jobs. We’ll go over what counts as a health insurance qualifying event below. 

What Happens During a Health Insurance Qualifying Event?

A qualifying event triggers what’s called a Special Enrollment Period (SEP). The SEP is a period of time during which you can choose a new plan outside of the annual Open Enrollment Period (OEP). 

If this is your first time taking out health insurance (for example, you’re about to turn 26), the SEP is an important step in taking charge of your own affairs. And even if you already have health insurance, an SEP is your chance to shop around for a new plan which may serve your needs better.   

How Long Do I Have to Act?

It depends on the type of qualifying event. You may have up to 60 days before the event, and/or up to 60 days after the event to enroll in a health plan.

For example, if you’re about to lose coverage due to turning 26, your enrollment period begins 60 days before the event, and ends 60 days after your birthday. And if you’re getting married, you have up to 60 days after the big day to choose a plan.   

Qualifying Life Events for Health Insurance

While this is not an exhaustive list, here’s a breakdown of the most common health insurance qualifying events. 

Change in Life Circumstances

Major life events trigger Special Enrollment Periods. Major events include births, adoption, deaths, marriage, and divorce. 

Loss of Health Insurance

If you lose health insurance, whether it’s because you turn 26, lose job-based coverage, or your eligibility changes, this qualifies you for a Special Enrollment Period. 

Residence Changes

If you’re moving to a different state (or even changing county or ZIP code), this is a qualifying event. It’s also a qualifying event if you’re a student moving to a new place for school, or you’re leaving sheltered housing. 

Other Qualifying Events

Other events which might trigger SEPs include becoming a US citizen, leaving prison or jail, or experiencing significant income changes.  

What Documents Do I Need to Prove a Qualifying Event?

It all comes down to what triggers the Special Enrollment Period. The documents you might need include:

• birth certificates
• death certificates
• divorce papers
• marriage papers
• rental agreement

At Healthedly, we can help you find, compare, and enroll in the best available individual and family health plans. Contact us now.