How to get health coverage outside of the open enrollment period

Your Guide to Understanding Qualifying Life Events and Special Enrollment

Life happens, and when it does, it is very likely that your health insurance coverage may need to change. When you encounter a qualifying life event that impacts your insurance needs, it is important to know that you can take advantage of a special enrollment period – since most people are unaware that they may enroll outside of open enrollment.

This guide is created to help you understand everything you need to know about qualifying life events and the special enrollment period.  You will learn whether or not you qualify and what documents you will need prior to enrolling and shopping for coverage. Let’s Begin!

#1 LOSS OF COVERAGE

DUE TO:
– Termination of group coverage
– Reduction of hours to part time status
– Loss of employer contribution
– Cobra ending

REQUIRED PROOF: Letter from employer, Certificate of credible coverage

#2 MARITAL STATUS CHANGE

DUE TO:
– Marriage
– Divorce
– Legal separation

REQUIRED PROOF: Marriage Certificate or divorce/separation court documents, Certificate of credible coverage

#3 DEPENDENT STATUS CHANGE

DUE TO:
– Birth of a child
– Adoption
– Aged out of dependent status

REQUIRED PROOF: Child’s DOB, Legal adoption paperwork, Certificate of credible coverage

#4 MOVING

Permanently move to another state and/or no longer live in the existing/prior plan’s service area.

REQUIRED PROOF:  New Mortgage Bill / Renter’s Agreement and Driver’s License, Utility (showing service start up charges), Postal Service change of address receipt (old address/new address/effective date) or Moving company receipt (indicates prior and current addresses)

#5 DEATH

Your primary policy holder passed away leaving you with no coverage.

REQUIRED PROOF: Death Certificate, Copy of termination letter from prior insurance company

#6 INCOME CHANGE

That makes you newly eligible or ineligible for a tax credit.

REQUIRED PROOF: Copy of certificate of creditable coverage OR a copy of the termination letter from prior Insurance Company and/or federal or state agency

#7 NON-CALENDAR YEAR

Your current plan ends on a non-calendar year basis.

REQUIRED PROOF: Copy of termination letter from prior insurance company OR Certificate of Credible Coverage

Anytime that you enroll in a plan you will be asked to provide the following information:

1. What was your qualifying event?

2. What was the date of this event?

3. You’ll be asked to submit supporting documents.

So how long is this special enrollment period? Typically, you only have 60 days from the QLE to enroll in a new plan due to ACA law, carriers are very strict on enrollment timelines.