Qualifying Life Events for Health Insurance
There are times when life changes unexpectedly. And when it does, those changes may occur outside the yearly Open Enrollment Period. To accommodate the unexpected, Special Enrollment Periods ensure you always receive essential health insurance coverage during qualifying life events.
What are qualifying life events?
Certain changes in your life situation are known as qualifying life events, like a loss of health coverage, a change in your household, or a change in residence. These qualifying events give you the opportunity to sign up for a new health insurance plan or modify an existing health insurance plan outside the traditional 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)
- Turning 26 and losing coverage from your parent’s health insurance plan
- Moving to a different ZIP code or county that changes your health plan area
How a qualifying life event works
Your health insurance provider gives you the chance to make changes to your health insurance plan typically up to 60 days after a qualifying life event. Known as Special Enrollment Periods, these exceptions help you make necessary updates to your health insurance coverage due to special circumstances. To determine your eligibility for a qualifying life event, notify your health insurance provider as soon as these circumstances arise.
Who is eligible for qualifying life events?
Because every event is different, you may need to present documentation to show how the event has impacted your health insurance coverage. Showing that you have lost coverage or that you need to change coverage to include a new family member are some examples of qualifying life events.
What kind of documents do I need for a qualifying life event?
Documentation requested often depends on the event.
- Birth certificates, adoption records, and marriage licenses show you have added family members and need to modify your health insurance coverage.
- Divorce papers or death certificates show that family members who provided health insurance have left you without coverage.
- New rental agreements or mortgages show that you have moved into a new health insurance plan area.
These are just a few of the types of documents you may need. If you think you are experiencing a qualifying life event, speak to your health insurance provider to see what documents might be necessary for eligibility.
What if you do not qualify for a Special Enrollment Period?
Some life-changing events are not considered a qualifying life event. But you do have options if you do not qualify.
- Apply for Medicaid. If you need health insurance and qualify, Medicaid accepts applications year-round.
- Apply for alternative health insurance solutions. Specialized health insurance plans like Anthem Enhanced Choice 1 are designed to provide coverage during changing life situations. The plans provide comprehensive coverage and are not restricted by enrollment periods.
Qualifying life events are not always clearly defined. That is why Anthem is here to help you better understand if your life event makes a difference in your health insurance coverage. Anthem can assist you with reviewing options for consistent health insurance protection through all life’s changes.
1 Anthem Enhanced Choice coverage is not required to comply with certain federal market requirements for health insurance, principally those contained in the Affordable Care Act. Be sure to check your policy carefully to make sure you are aware of any exclusions or limitations regarding coverage of preexisting conditions or health benefits (such as hospitalization, emergency services, maternity care, preventive care, prescription drugs, and mental health and substance use disorder services). Your policy might also have lifetime and/or annual dollar limits on health benefits. If this coverage expires or you lose eligibility for this coverage, you might have to wait until an open enrollment period to get other health insurance coverage.
