Qualifying Life Events

If you’re like most folks, you may think a “qualifying event” is the mere fact that you need health insurance. Unfortunately, it’s a bit more complicated than that, which is why I thought I’d take a minute to give you the low down.

Outside of open enrollment (November 15, 2014 to February 15, 2015), you can purchase a health insurance plan only if your current plan is changing or you experience a major life event.* When you experience one of these events (known as a qualifying life event), you are eligible for a special enrollment period and you will be able to enroll or change your health insurance within 60 days of the event (or 30 days for employer or group plans.)

What events would qualify you for a special enrollment period?**

1. Your health insurance plan is changing to include the new benefits required under health care reform in 2014
2. Renewal of an individual medical plan in 2014 (grandfathered or non-grandfathered)***
3. You lose health insurance that is Minimum Essential Coverage due to:
   • Discontinuation of a current plan that does not meet health care reform requirements
   • Employer no longer offering group health insurance
   • No longer qualify for government-sponsored insurance
   • Divorce or legal separation
   • Termination of a domestic partnership or civil union (in states where applicable)
   • Change in full time employment status
   • Voluntary or involuntary termination of employment
   • Death of parent or spouse
   • Change in dependent status (i.e. dependent child turning 26 years old)
   • Change in student status; for example, graduating from college
4. You are gaining or becoming a dependent due to:
   • Marriage
   • Domestic partnership (in states where applicable)
   • Birth of child/children
   • Adoption of child/children
   • Placement for adoption of child/children
   • Guardianship/court ordered dependent
5. Other:
   • Permanently moving to a new state
   • Return from active duty
   • Release from incarceration
   • Gaining citizenship or valid immigration status

Will you need to provide proof of the qualifying event?

Yes. During the application process, you will be alerted to the specific requirements needed to demonstrate proof of the qualifying life event.

If you have a qualifying life event, when will your plan start?

In most cases, your requested effective date needs to be on or after the date of the qualifying life event. (However, for a special enrollment period based on renewal of your existing individual medical plan, an effective date as early as 30 days prior to your current plan’s renewal date may be available.) Your coverage start date may be updated based on your life event details (application submission date, date event occurs, state specific rules, etc.). Your carrier will notify you of any such change when you apply.

Additional effective date options may be available beyond those originally presented when getting a quote. If this case, such options will be made available after you submit an application. (Let me know if you have questions about this process).

What if you do NOT have a qualifying life event?

If you do not have a qualifying life event or a state exception, you will not be able to purchase health insurance coverage until the next open enrollment period.* Enrollment starts November 15, 2014 for plans with effective dates starting January 1, 2015.

The good news is, there are other options available to you, such as medical cost sharing, which you can read about here. Contact me to discuss your specific situation and possible options.

Not sure if you have a qualifying life event?

If you’re still not sure, just ask. But remember to take action right away so that your window doesn’t close (within 60 days of the event.)

*In Nevada, 2014 Major Medical plans can be purchased year round without a qualifying life event. If you apply without a qualifying life event, your coverage will begin on the first day of the month after 90 days from the date you applied.

**You will not qualify for a special enrollment period if you terminate coverage voluntarily, your coverage is terminated due to fraud, you fail to pay a premium, or you lose coverage for plans like Short Term Medical or Fixed-Benefit Insurance.

***Individual medical plans are medical insurance policies that are Minimum Essential Coverage for individuals and families (not employer-sponsored group coverage).