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Qualifying life event

In health care terms, a qualifying life event is a circumstance or occurrence that makes an employee eligible for a special enrollment period. This allows employees to enroll in coverage by a health insurance plan outside of the annual open enrollment period offered by their employer, insurance company, or state or federal government.

As laid out in the Affordable Care Act, qualifying events might include:

  • Losing health coverage, including individual health insurance, job-based coverage; student health plans; Medicare, Medicaid, or CHIP eligibility; or aging out of a parent’s health coverage
  • Life changes such as birth, adoption, marriage, divorce, or death in the family
  • Changes in residence such as relocating to a new ZIP code, moving to attend school, or entering or leaving transitional housing
  • Gaining a new dependent or becoming someone else’s dependent due to a court order
  • Exiting a relationship involving domestic abuse or spousal abandonment

This is just a selection of the many qualifying health and life events that may make you eligible for a special enrollment period. The website offers a more complete listing. Depending on how you qualify for a special enrollment, you will generally have 60 days before or after the event to apply.

In relation to benefits, take a look at our open enrollment checklist that helps you ensure you are covering the bases of open enrollment in your organization.

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