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Qualifying Life Events and the Impact on Health Insurance

By Christie Wright | Published June 1, 2023 | No Comments

There are times when life changes unexpectedly. And when it does, those changes may occur outside of your company’s annual open enrollment period. To accommodate the unexpected, special enrollment periods ensure you always receive needed health insurance coverage during qualifying life events.

How long do I have to select a health insurance plan or switch to a different plan if I experience a qualifying life event?

If you experience a qualifying life event (QLE), you have 60 days to change your insurance plan. Depending on the qualifying event, you may have a special enrollment window that begins 60 days before the event and continues for 60 days after the event.

In most cases, the coverage will be effective the first of the following month if you enroll by the 15th of the month. But there are different effective date rules for marriage, birth or adoption of a child, and loss of other coverage.

Your employer will also grant you a special enrollment period with a qualifying life event (QLE). Check with your HR department for details and required carrier documentation.

What Is A Qualifying Life Event for Health Insurance?

When you experience a qualifying life event (QLE), you have the opportunity to add or change coverage for yourself or additional family members. These qualifying events allow you to sign up for a new health insurance plan or change an existing health insurance plan outside the normal Open Enrollment Period.

Qualifying life events typically include, but are not limited to:

• Becoming newly married or divorced.
  
• Having a baby or adopting a child.
  
• Experiencing a death of the insurer in the family.
  
• Losing health insurance coverage due to job loss.
  
• Losing eligibility for Medicare, Medicaid, or Children’s Health Insurance Program (CHIP).
  
• Children aging out of their current plan (turning 26) and losing coverage from their parent’s health insurance plan.
  
• Moving to a different zip code or county can change your health plan area.

HR managers are well prepared to address the questions from employees needing to change or update their insurance plan elections when an employee is experiencing a qualifying life event.