What Is a Qualifying Life Event for Insurance?

For a few weeks each year, Americans can sign up for or change their health insurance during a period known as open enrollment.

When exactly this period falls depends on whether you’re buying employer-sponsored or independent coverage. If you’re buying coverage through your employer, enrollment will typically be open for a few weeks between October and December. If you are buying your own coverage through one of the marketplaces set up by the Affordable Care Act, open enrollment typically begins on November 1 and runs through January 15.

But what if your health insurance needs change outside this window?

If you experience what’s known as a “qualifying life event,” you may be able to purchase coverage—regardless of the time of year.

Below, we discuss what a qualifying event is and how it affects your insurance. We also share some of the most common types of qualifying life events, so you can plan ahead.

What is a qualifying life event, and how does it work?

A qualifying life event (QLE) is an event that significantly changes your situation in life, like having a baby or getting married. If you experience one of these events, you’re eligible to either change your health insurance or purchase new coverage during a special enrollment period that falls outside open enrollment.

The Department of Health and Human Services, which runs the federal health insurance exchange, classifies qualifying life events into four broad buckets:

• Loss of coverage: If you lose your existing health insurance, you may become eligible to purchase coverage.
• Changes in household: If you get married or divorced, have or adopt a child or experience a death in the family that changes your coverage needs, it can trigger a special enrollment period.
• Changes in residence: If you’ve moved to a new zip code, county or state, you may be eligible to change to coverage that’s more local to your new residence.
• Other qualifying events: This includes all other reasons that can trigger a special enrollment period, like becoming a U.S. citizen, leaving prison or experiencing a change in income level that affects the type of coverage you qualify for.

Typically, once you experience a qualifying life event, you’ll have a 60-day window after the event to purchase coverage.

It’s important to note that in order to enroll or make changes, you may be asked to provide some supporting proof, such as a birth or marriage certificate.

List of qualifying life events for health insurance

Here’s a list of some of the most common types of qualifying life events you may encounter and some information about each:

1. Losing or changing your job

Health insurance is one of the most common benefits that businesses offer their employees. Getting health insurance from your employer can result in significant savings when compared to the cost of buying coverage on your own. The downside? Leaving your job (whether you are fired, furloughed, laid off or you quit) also means leaving coverage behind. (If you lose your job, you could stay on your current policy for a period by opting for COBRA coverage. However, this can be pricey.)

The good news, however, is that leaving your job for any reason makes you eligible for a 60-day special enrollment period that begins the day you lose your employer-sponsored coverage. This would apply in situations when you lose coverage due to a job change—like if you leave your employer for another employer, choose to go part time and are no longer eligible for coverage or get a new job that doesn’t offer insurance.

So, when you get a new job, you'll be able to enroll in your new employer’s benefits, if they offer them. If your spouse is the one that got a new job, your family could be eligible to enroll in benefits at your job, too (if your spouse was previously the policyholder).

2. Aging out your parents' health insurance plan

The Affordable Care Act allows for children to stay on their parents’ employer-sponsored health insurance policy until they turn 26—regardless of whether they live with their parents or their parents claim them as a dependent.

If a parent has health insurance through an employer, a special enrollment period will begin 60 days before their child loses coverage and extend for 60 days after they lose coverage, allowing for plenty of time to find coverage of their own. If the health insurance plan is through an ACA marketplace, the child can stay covered by the parents’ policy until December 31 in the year they turn 26.

3. Getting married or divorced

Before you get married, you and your spouse will likely each have your own health insurance policies. But after you get married, you might find it’s more efficient for one of you to migrate over to the other’s policy.

Your special enrollment period begins on the day of your marriage and lasts for 60 days. To enroll your spouse in your plan, you may be asked to provide a marriage certificate as proof of the life event.

Likewise, if you and your partner get divorced or legally separated, you’re entitled to a special enrollment period. This period will last for 60 days following the divorce, separation or court order.

4. Growing your family

Another big family change that can change your health insurance needs and trigger a special enrollment period is having a baby, adopting or becoming the legal guardian of a child. This is sometimes called the “new dependent special enrollment period.”

The special enrollment period for adding a child to your family will typically be at least 30 days for employer-sponsored plans and a maximum of 60 days for marketplace plans. Coverage is usually retroactive to the date of your child’s birth or adoption.

5. Experiencing a death in the family

If one of the individuals covered on your family plan passes away, you may be eligible to make changes to your policy or find new coverage. This can be true whether the individual who has passed was the primary policyholder, a spouse or a dependent. The special enrollment period for a death in the family is 60 days past the date of death.

6. Moving

Moving to a new area permanently? You may be entitled to a special enrollment period, as long as there are different health insurance plans available in the area you’re moving to (even if you’re not going out of state). The permanent move special enrollment period starts 60 days from the date of your move.

7. Changing residency status

If your residence status in the United States changes, it may trigger a special enrollment period. This is true for individuals (and their families) who become U.S. citizens, U.S. nationals or lawfully present residents.

If you are purchasing health coverage through a marketplace plan, the special enrollment period will typically last for 60 days starting on the date that your residence status changes. Employer-sponsored plans have the discretion to determine if they will offer such an enrollment period and, if so, how long it will be.

Adapting to life’s changes

Chances are, if you’re experiencing a qualifying life event, health insurance isn’t the only thing you should be looking at. Life changes are a great time to revisit the protection you have in place for your family on a larger scale, too.

When experiencing these life changes, you’ll likely benefit from adjusting your monthly budget, updating your savings goals or revisiting your insurance coverage—including life insurance and disability insurance.

Your financial advisor can help you think about what you might adjust while experiencing a life change. They can also recommend strategies to help you move away from just protecting your family to growing and protecting your money. With a holistic approach in place, your advisor can help you reach your financial goals—especially as life changes.

Certified Financial Planner Board of Standards Center for Financial Planning, Inc. owns and licenses the certification marks CFP^®, CERTIFIED FINANCIAL PLANNER^®, and CFP^® (with plaque design) in the United States to Certified Financial Planner Board of Standards, Inc., which authorizes individuals who successfully complete the organization’s initial and ongoing certification requirements to use the certification marks.