What is a “Qualifying Life Event” in Health Insurance?

During the “Open Enrollment” period, many Americans shop for health insurance. Most people think this is the only time they can make changes to their health insurance, but it’s not. If you experience a “Qualifying Life Event” (QLE), (within the last 60 days in all cases), you may be able to sign up for health insurance outside the Open Enrollment Period or make changes to your existing plan. Understanding which situations are considered qualifying life events will help you make smart decisions regarding your coverage.

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Defining a Qualifying Life Event in Health Insurance

Situations That Are Considered Qualifying Life Events

If you experience a major life change, then such a change is often considered a qualifying life event. Such life events affect your existing health insurance coverage and can make you eligible to change your coverage during the special enrollment period which is 60 days from the date of your “life event”.

Change in Family Status with Your Health Insurance

If you’ve gotten married, divorced (and lost coverage), your household size has changed because you’ve had a baby, or a household member has moved out, then you’ll most likely be able to change your health insurance. This would be considered a qualifying life event. Court-ordered dependent changes are also considered a qualifying life event for health insurance.

Change in Residence Can Affect Health Insurance Coverage

Changing where you live could trigger a qualifying life event for health insurance. Moving to a different state, into a permanent residence, and losing your coverage because of the move is considered a qualifying life event. A student who changes residences could also trigger a qualifying life event for health insurance.

Change in Eligibility for Assistance Paying for Health Insurance Coverage

If you were eligible for certain types of coverage, such as Medicaid or the Children’s Health Insurance Program, and received assistance paying for coverage, but you subsequently have been denied coverage, then you can shop health insurance plans outside the open enrollment period. This would be considered a Life Event.

Special Situations That Can Affect Your Health Insurance

Special situations that are outside of the standard qualifying life events previously discussed may take place that would allow you to sign up for health insurance during a 60-day special enrollment period. Such situations are considered complex issues that are subject to review on a case-by-case basis to determine if a qualifying life event has taken place.

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Situations That Are Not Qualifying Life Events for Health Insurance

Although qualifying life events seem self-explanatory, there are times when such situations would not qualify you to enroll in a health insurance plan during the special enrollment period. For instance, while divorce typically is a situation that is considered a qualifying life event for health insurance, it is only such if it results in a loss of health insurance coverage. If there’s no change in your coverage, then this is not considered a qualifying life event, and you cannot enroll in a health insurance plan. Dropping your existing insurance willingly or having your insurance canceled because of failure to pay the health insurance premium will not allow you to seek new insurance during the year. You’d need to wait for “Open Enrollment” again which is November 1st through January 15th (end date can change year to year, call us for this years end date).


Seek the Help of a Professional at Nevada Insurance Enrollment

Navigating health insurance plans and enrollment periods can be confusing. Seek the advice of an experienced health insurance agent to ensure you receive the best health insurance coverage.

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