Qualifying Life Event (QLE)
What Is a Qualifying Life Event?
A qualifying life event, or QLE, refers to a change in situation that makes you eligible for a Special Enrollment Period.
Without a qualifying life event, you may only make changes to your health insurance coverage during the Open Enrollment Period each year. Your qualifying life event will usually give you a 60 day window outside of the Open Enrollment Period to add, drop, or change your health insurance plan.
What Are Considered Qualifying Life Events?
Qualifying life events can be grouped into four different categories:
Loss of Health Coverage
If you recently lost your insurance coverage due to a job loss, a job change, the end of a student health plan, or turning 26 and losing eligibility under your parent’s plan, these are qualifying life events. In addition, losing eligibility for CHIP, Medicare or Medicaid is a qualifying life event.
Changes in the Household
This is perhaps the easiest category of qualifying events to understand. Getting married, divorced or separated, or experiencing a death in the family can all count as a qualifying event. Having or adopting a child also count as a qualifying life event.
Changes in Residency
If you have moved to a different country or ZIP code, moved to attend school, moved due to seasonal employment or moved to or from transitional housing, these are considered qualifying life events.
Other Qualifying Events
All other qualifying events fall into this category and can include leaving jail or prison, becoming a United States citizen and having a change in income that affects the coverage you can qualify for. Gaining membership into a federally recognized tribe or achieving status as an Alaska Native Claims Settlement Act Corporation shareholder also are qualifying life events.
Proof of Qualifying Life Events
If you are using a qualifying life event to add, drop or change healthcare coverage, you will be required to provide proof. The proof required will vary depending on the qualifying life event you have experienced.
For example, if you had a baby, you will need to provide a birth certificate and possibly a Social Security number. If your spouse died, leaving you without coverage, you will need to provide a death certificate. If you moved, you will need to provide proof of an address change.
Enrolling in Health Insurance After Open Enrollment
If you missed the Open Enrollment Period deadline for your employer or for insurance through the marketplace, you may be able to obtain short-term health insurance until the next Open Enrollment Period or until you have a qualifying life event.
Keep in mind that some short-term health insurance plans may not be qualified health plans, and you still may be required to pay the individual mandate fine. To avoid the fine, some private health insurance companies will allow you to enroll outside of the open enrollment, or Special Enrollment Periods.
Using Qualifying Life Events to Your Advantage
Perhaps you forgot to enroll in your employer's dental plan during your last Open Enrollment Period. Now, you have just adopted a baby, which allows you to make changes to your insurance plans. You can add your new baby to your health insurance plan and also add dental coverage for your family.
If you have recently had a qualifying life event, or want to see if you are eligible for a Special Enrollment Period, give one of our experienced agents a call at 858-771-4087 or enter you zip code here!