Understanding Qualifying life Event for Health Insurance

qualifying life events

Sometimes life happens unexpectedly. These unexpected changes can occur outside of the yearly Open Enrollment Period. You can expect the unexpected with Special Enrollment Periods. Special Enrollment Periods ensure that you receive essential health coverage during life events.

A Special Enrollment Period is available to ensure you can purchase essential health insurance coverage during certain life events.

What is a Qualifying Life Event?

Qualifying life events are changes that occur in your life, such as a loss in health coverage or a change of household or residence. These events can allow you to change or sign up for a new health insurance plan.

These are some of the most common qualifying life events.

Remarried or in the process of a divorce?
Adopting or having a baby.
A family member dies because of an accident.
Job loss can result in your losing your health insurance coverage.
Loss of eligibility for Medicare, Medicaid, and the Children’s Health Insurance Programs (CHIP).
You turn 26 and lose coverage under your parent’s insurance plan.
You can move to another zip code or county and change your health insurance area.

Every situation is unique, so you must provide documentation showing how your life events impact your insurance coverage.

What a Qualifying Life Event Looks Like

Your insurance company allows changing your health insurance plan, usually within 60 days of a qualifying event. These exceptions allow you to make changes to your insurance coverage in the event of exceptional circumstances. Notify your insurance provider immediately if you have questions about your qualifying event eligibility.

What documents do I need to qualify for a life event?

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Documentation is often dependent on the event. It could include:

  1. Birth certificates, adoption records and marriage licenses show that you have added family members or need to change your health insurance coverage.

  2. You can also get divorce papers or death certificates to show that your family members have not provided you with health insurance.
  3. You have moved to a new area of health insurance and signed new rental agreements.

These are only a few examples of the documents you might need. Talk to your insurance provider if you have a qualifying life event.

What if I don’t qualify for a special enrollment period?

Certain life-changing events do not qualify as life events. If you don’t qualify, you still have options. You may be eligible to:

Apply for Medicaid. Medicaid is open to anyone who qualifies for health insurance.

You can apply for other health insurance options. These specialized insurance plans, such as Anthem Extended Choice , are intended to cover you in changing circumstances. These plans offer comprehensive coverage without restrictions and do not require enrollment.

When you experience a life-changing event, you deserve to rest assured that your health and safety are protected. Unfortunately, it can be challenging to define what qualifies for insurance. Anthem can help you determine if any life events affect your insurance coverage. In addition, Anthem can help you evaluate your options for health plan coverage that will be consistent with all life changes.

1Anthem-Enhanced Choice coverage does not have to meet certain federal market requirements, principally the Affordable Care Act. You should carefully review your policy to ensure you are aware of any limitations or exclusions regarding preexisting conditions and health benefits. Part of the policy to review includes hospitalization, emergency, maternity, and preventive care. You might also find that your policy has annual and lifetime dollar limits for health benefits. You might need to wait until open enrollment to obtain other coverage if your coverage ends or you cannot receive it.

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