Health Insurance: What is a Qualifying Event?

It’s important to have sufficient health insurance coverage for yourself and your family, at a price that you can afford. As an independent insurance agency, we can help you shop around and compare plans from different companies, to find the coverage that is right for you. However, when purchasing health insurance, timing is everything. Under the Affordable Care Act (ACA), there are rules around when you can request changes or enroll in new coverage.

Open enrollment on the Health Insurance Marketplace typically begins in November of each year and lasts for three months through the end of January the following year. Once open enrollment is closed, most individuals must keep their existing coverage until the next annual open enrollment period. However, there are still opportunities to update existing coverage or enroll in new coverage through a special enrollment period.


What is a Special Enrollment Period?

A special enrollment period is time outside of the open enrollment period when you have a right to make changes to, or sign up for, health coverage because you experience a qualified life event. Individuals who experience a life event generally can begin looking for coverage 90 days prior to the event and have 60 days following the event to make changes to their coverage.

Here are qualifying events that would trigger a special enrollment period, and the documentation needed for each:

Type of EventDocumentation Required
Birth of a childBirth certificate or birth record
Adoption or placement for adoptionAdoption papers or court order with judge’s signature
MarriageMarriage certificate
Reached dependent age limit (age 26)Certificate of Creditable Coverage and/or term letter with the date and reason coverage was lost
Permanent move that provides access to new Qualified Health PlanDated utility bill, bank statement, lease or other form with new address
Involuntary loss of Minimum Essential CoverageCertificate of Creditable Coverage and/or term letter with the date and reason coverage was lost
COBRA expirationTerm letter with the reason the coverage was terminated
Exchange exemptionLetter/documentation from exchange stating that there was an error/exemption

If you have questions about your health insurance coverage, or whether or not you qualify for a special enrollment period, contact us today for assistance. We’re here to help!

Source: Medica