Your Guide to Understanding Qualifying Life Events and Special Enrollment
Life happens, and when it does, it is very likely that your health insurance coverage may need to change. When you encounter a qualifying life event that impacts your insurance needs, it is important to know that you can take advantage of a special enrollment period – since most people are unaware that they may enroll outside of open enrollment.
This guide is created to help you understand everything you need to know about qualifying life events and the special enrollment period. You will learn whether or not you qualify and what documents you will need prior to enrolling and shopping for coverage. Let’s Begin!
#1 LOSS OF COVERAGE
– Termination of group coverage
– Reduction of hours to part-time status
– Loss of employer contribution
– Cobra ending
REQUIRED PROOF: Letter from employer, Certificate of credible coverage
#2 MARITAL STATUS CHANGE
– Legal separation
REQUIRED PROOF: Marriage Certificate or divorce/separation court documents, Certificate of credible coverage
#3 DEPENDENT STATUS CHANGE
– Birth of a child
– Aged out of dependent status
REQUIRED PROOF: Child’s DOB, Legal adoption paperwork, Certificate of credible coverage
Permanently move to another state and/or no longer live in the existing/prior plan’s service area.
REQUIRED PROOF: New Mortgage Bill/Renter’s Agreement and drivers license, utility, Postal Service change of address receipt
Your primary policy holder passed away leaving you with no coverage.
REQUIRED PROOF: Death Certificate, Copy of termination letter from prior insurance company
#6 INCOME CHANGE
That makes you newly eligible or ineligible for a tax credit.
REQUIRED PROOF: Copy of certificate of creditable coverage OR a copy of the termination letter from prior Insurance Company and/or federal or state agency
#7 NON-CALENDAR YEAR
Your current plan ends on a non-calendar year basis.
REQUIRED PROOF: Copy of termination letter from prior insurance company OR Certificate of Credible Coverage
Anytime that you enroll in a plan you will be asked to provide the following information:
1. What was your qualifying event?
2. What was the date of this event?
3. You’ll be asked to submit supporting documents.
So how long is this special enrollment period? Typically, you only have 60 days from the QLE to enroll in a new plan due to ACA law, carriers are very strict on enrollment timelines.
If you still need coverage and none of these apply to you – we may have other solutions for you such as Supplemental Health and Short Term Medical.
The high cost of major medical coverage is forcing individuals to shoulder an increasingly larger share of their medical costs through higher deductibles and larger co-pays in order to keep premiums in check. This new program, a Member Group Supplemental Health insurance plan is a specially priced group plan for members, designed to help you pay for out-of-pocket living and healthcare expenses like hospital stays, diagnostic tests, and more. To learn more about Supplemental Health, click here.
Short Term Medical
Short Term health insurance plans are designed to provide temporary health care insurance during unexpected coverage gaps. With a Short Term Medical policy, you choose how the coverage fits your needs or the needs of your family. To learn more about this solution visit our health insurance page.