Life can be so unpredictable, and situations can change in an instant. In the world of health insurance, the term “qualifying life event” is very important for individuals and families who are looking to change their insurance coverage outside the usual enrollment periods.
From a change in marital status to employment status, qualifying life events act as an essential point or phase that allows people to adjust their insurance policies to meet their ever-changing needs.
Hence, if you are thinking of a change to life insurance, health insurance, or another form of insurance coverage, having an understanding of the qualifying life events is important when it comes to decision-making as it gives you peace of mind and protects your well-being.
What Is a Qualifying Life Event for Insurance?
A qualifying life event, also known as QLE in the world of insurance, is a major change in a person’s insurance coverage outside the normal enrollment period.
These events cause a special enrollment period during which families or individuals can change their insurance plan to reflect their current life situations.
Additionally, qualifying life events play an important role in making sure that people have access to their required coverage for protection for themselves and their families during this change.
How Does It Work?
A qualifying life event is a big and crucial change in a person’s life state of affairs that causes a specific enrollment period for insurance coverage.
During this period, the policyholder as well as their families are free and able to make changes to their insurance plan outside the open enrollment period.
With this opportunity, you can make changes to coverage to meet your current needs. Meanwhile, qualifying life events can differ from changes in employment status to major events like the birth of a child, marriage, or divorce.
Hence, when a qualifying life event takes place, the person has a limited time to make these changes without any penalty.
Types of Qualifying Life Events
Here are different situations that can cause a special enrollment period for insurance coverage:
- Change in Employment Status: This may involve losing or gaining a job, experiencing a reduction in work hours, or changes between jobs.
- Moving: Relocating to a new residence that causes a change in qualification for insurance coverage.
- Changes in Family Status: Marriage, the adoption or birth of a child, divorce, the death of a dependent or spouse, or legal separation are all qualifying life events.
- Special Circumstances: Circumstances like being released from incarceration, becoming a U.S. citizen, or being declared unqualified for CHIP or Medicaid may also qualify as eligible life events.
- Loss of Other Coverage: This includes losing coverage under another insurance policy, like coverage through a parent’s plan or employer-sponsored coverage.
- Significant Income Change: An increase or decrease in income that affects qualification for subsidies or other forms of financial assistance with insurance premiums.
How Long Do You Have for a Qualifying Event?
A unique enrollment period usually lasts 30 to 60 days before or after the qualifying life event, when the policyholder can make adjustments to their existing plan or sign up for a new health insurance policy. Here are the three dates you need to check with your plan to confirm coverage:
- The date your coverage begins.
- The date your eligibility is verified.
- The date of your first premium payment.
Qualifying Life Event Documentation Required
Different qualifying life events need certain documentation. They include:
- S. Citizenship: Naturalization Proof.
- Unemployment: Termination letter.
- Parenthood: Birth certificate or adoption record.
- Death: Death certificate.
- Marriage: Marriage certificate.
- Aging out of a parent’s plan: Evidence of previous coverage within the previous 60 days.
- Divorce or Separation: Filed court papers.
- Government Enrollment Error: A signed statement or affidavit.
- Moving: Proof of residency from old and new addresses.
- Military Discharge: Certificate of release.
Frequently Asked Questions
Is getting a new job a qualifying event?
Yes, losing or getting a job is part of changes in employment status. So, it is classified as a qualifying event as it can cause a unique enrollment period for insurance coverage.
Is getting pregnant a qualifying event?
Although pregnancy itself might not be a qualifying life event, the birth of a child usually qualifies as a qualifying event, enabling policyholders to make changes to their insurance coverage to add the new dependent to the policy.
Is it a qualifying event if your spouse gets a new job?
Yes, changes in employment status, even for a spouse, like gaining or losing a job or changing between jobs, can be classified as a qualifying life event that can cause a special enrollment period for insurance coverage for both the policyholder and their dependents.
Is changing jobs a qualifying event?
Yes, as mentioned earlier, changing jobs, losing or gaining a job, or having a reduction in work hours usually classifies as a life event that causes an enrollment period for insurance coverage outside the regular period.
Is a spouse quitting a job a qualifying event?
Yes, quitting a job or other significant changes in employment status can be considered a qualifying life event that causes an exceptional enrollment period for insurance coverage for both the policyholder and their dependents.
Is a Furlough a qualifying event?
Yes, a furlough is considered a qualifying life event under certain circumstances. This may be considered a qualifying event if it ends up with your employer dropping coverage or you losing your eligibility. Nevertheless, if your employer increases coverage and eligibility throughout the leave period, it is not allowed.
