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What Are Qualifying Life Events for Insurance?

Health insurance can help lower the cost of medical care, from regular checkups to major procedures. As a result, it's a crucial form of coverage for you and your loved ones. Most people can only enroll in a new health plan during open enrollment each year. However, qualifying life events may allow you to enroll in a new plan outside open enrollment.1 Read on to learn about qualifying life event insurance rules and when you may be eligible for a special enrollment period.

3 min. read

Table of Contents

What is a qualifying life event for health insurance

A qualifying life event for insurance is a major change in your circumstances that can impact your insurance needs. A qualifying life event makes you eligible for a special enrollment period so you can switch to a new plan outside regular health insurance enrollment.

Types of qualifying life events

Many major life changes may count as qualifying life events, including:3

Getting married

Getting married can have a significant impact on your financial and legal status. For example, you may need to provide health coverage for your spouse. As a result, marriage makes you eligible for a special enrollment period.

Getting divorced or legally separated

Divorce or legal separation may alter your health coverage needs, especially if it causes you to lose your insurance through your former spouse. For this reason, these events count as qualifying life events.

Having or adopting children

Having or adopting a child is a qualifying life event because you must provide them with health coverage. In turn, you can select a new plan that covers your growing family’s needs during a special enrollment period.

Turning 26

When you turn 26, you may lose access to your parents' health insurance. Thus, turning 26 is often considered a qualifying life event.

Turning 65

When you turn 65, you typically become eligible for Medicare, which may alter the type or amount of private health insurance coverage you need.3 As a result, turning 65 may qualify you for a special enrollment period, whether you want to adjust, add or reduce your private coverage outside Medicare.

Experiencing a change in employment status

If your employer reduces your hours or lays you off, the change may qualify you for a special enrollment period. However, changing jobs within the same organization or receiving a promotion doesn’t count as a qualifying life event.

Changing your address

Health insurance varies widely by location, so moving to a new address can be a qualifying life event. What qualifies as a new area depends on local health insurance regulations. In general, moving to a new ZIP code may make you eligible for the special enrollment period.

Other qualifying life events

Along with the circumstances outlined above, some other qualifying life events include:

  • Losing Medicare, Medicaid or CHIP coverage eligibility
  • Losing health coverage due to changes in your student status
  • Experiencing income changes that impact your coverage qualifications
  • Becoming a U.S. citizen
  • Leaving incarceration
  • Experiencing a death in the family
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What to do if you experience a qualifying life event

If you experience a qualifying life event, you can obtain new health coverage by following these steps.

  • Review your existing health insurance plan: Look over your current policy to see the rules and deadlines for reporting a qualifying life event
  • Gather necessary documentation: Gather documents proving the change, such as a marriage certificate, proof of address change, birth certificate, divorce decree, legal separation document, a layoff notification or a notification of a loss of coverage.
  • Notify your health insurance company: Tell your insurer about your qualifying life event as soon as possible.
  • Explore your coverage options: Compare health insurance plans through your insurer and the health insurance marketplace. Consider each plan's premiums, coverage, providers, deductibles and other relevant factors to compare how much health insurance costs.
  • Apply for your chosen plan: Apply for the plan that fits your needs and submit any necessary documentation to prove the qualifying life event.
  • Confirm your enrollment and start date: When approved, confirm your effective start date to make sure your new coverage starts before or when your old coverage ends.
  • Pay your first premium: Once your new coverage starts, pay your first premium and consider setting up automatic payments.
  • Inform your health providers and find new ones, if needed: Contact your health care providers to inform them of your new coverage to ensure proper billing.

Additionally, you may need to find new providers if your covered providers have changed.

How much time do I have to make changes after a qualifying life event?

The amount of time you have to make changes depends on the type of health plan. For Marketplace health plans, you usually have 60 days before or 60 days after the qualifying life event to enroll or change plans. For employer-sponsored plans, you typically need to request special enrollment within 30 days of the event.4 Regardless of the specific timeline, it’s important to act quickly. If you miss your special enrollment period, you may need to wait until the next open enrollment period to get a new plan.

Get a quote for Aflac’s supplemental health insurance

Insurers understand that life can change, and so can your health insurance needs. That’s why major events like marriage, divorce, legal separation, having children and turning 65 allow you to change your coverage outside the normal open enrollment period.

If you need additional coverage, you can always apply for a supplemental insurance policy through Aflac. We offer a wide variety of plans, including critical illness, accident, life and dental insurance.

Chat with an agent today to explore our coverage options and get a quote.

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