Qualifying Life Events and the Special Enrollment Period

Health insurance helps provide individuals and families access to care and can make a difference between illness and health. In the U.S., there are about
327 million people, most of whom have private health insurance. If you need to join the ranks of the insured or if your health insurance coverage no longer suits your or your family’s needs, it may be time to approach a health insurance broker to change your coverage.



In the U.S., there is a specific window of time when you can enroll or change your healthcare coverage. This period is called the Open Enrollment Period. OEP tends to last from November to mid-January. However, if you need to enroll outside of the typical timeframe, there are life events that can qualify you for a Special Enrollment Period.

Approaching a Health Insurance Broker About the Special Enrollment Period

To obtain insurance, a broker can assist you in finding and applying for adequate coverage for your situation. Brokers may work with single health insurance companies or several, but all brokers can help you navigate the SEP. The SEP allows you to
enroll in health insurance outside of the normal OEP. However, you must undergo a specific life change or qualifying life event to trigger the SEP.

The SEP begins from your qualifying life event date and will extend for about 60 days. The specifics of your SEP window depend on the state you live in. For example, some states will give you a 60-day window before and after the QLE to seek coverage.

Understanding Qualifying Life Events

The basic understanding of QLEs is that QLEs change your individual or household’s status. Another term for QLE is a qualified status change.

A Change in Marital Status

When you marry, divorce or legally separate, your household size changes. You typically have 60 days from your wedding date to enroll in a plan with your spouse or to add a spouse to an employer-sponsored plan.

In the case of a divorce, the person who does not hold the policy will have to purchase a new policy through the SEP. You may need to present your divorce decree or proof of separation to qualify.

An Increase or Decrease in Household Size

Starting a family is a reason to seek a health insurance broker for a new plan. Remember that pregnancy does not count as a QLE; the baby’s birth does count as a QLE. In addition to giving birth, adoption also makes you eligible for a special enrollment period.

In addition to births, deaths in the family can also qualify you for a change in your coverage. You are eligible if you share coverage with another family member and he or she passes away.

A Move Outside of Your Coverage Range

Moving out of your health plan’s coverage range generally qualifies you to change your insurance plan. Moving can include leaving a transitional house, shelter or moving to a college campus.

Changes To Your Job Status or Income

No matter how you lose your job, if you lose your job, you are eligible. You don’t have to wait until open enrollment, even if you voluntarily quit. Likewise, if you are covered under your spouse’s plan and he or she changes employment, both of you qualify.

Additionally, you may be eligible if you are covered under Medicaid and your income increases or you no longer receive Medicaid.

Determining Whether You Have a QLE

The special enrollment window applies to most people who lost their health insurance involuntarily. Most qualifying events are ones the individual or family had little control over. The fact that you lost your insurance has to be a byproduct of the event.

However, if you give up your insurance voluntarily, you do not qualify for the SEP. Voluntary insurance loss includes not paying your insurance premium or dropping out of an insurance plan.

Trusting a Health Insurance Broker To Guide You During a SEP

The open enrollment period for health insurance doesn’t always work for everyone. You cannot always predict when you’ll have to change coverage and because of life’s uncertainties, there are special enrollment periods where you can still seek the insurance you need.

To navigate the complexities of the insurance market, you may want a health insurance broker. For more information about enrolling in private or family health care insurance coverage outside of open enrollment, contact Sackett & Associates Insurance Services at (707) 823-3689 today or
request a quote on our website.