What is a Qualifying Life Event?

A qualifying life event (QLE) is a major change that makes you eligible to shop for health insurance outside the regular open enrollment period. These changes can include things like marriage, having a baby, or moving to a new state. Depending on the circumstances, you may also be able to switch Medicare plans. The ACA, more commonly known as Obamacare, allows people who experience certain qualifying events to sign up for coverage through the exchanges. The QLEs are designed to ensure that people do not have lapses in health insurance when they are going through big changes in their lives.

For example, if you lose your job and are unable to continue your employer’s health insurance plan, this is considered a qualifying life event. This will trigger a special enrollment period, during which you can buy an individual plan through the marketplace or extend your current coverage under COBRA.

A few additional situations can also be considered a qualifying life event. For example, this is a qualifying event if you divorce and need to remove your former spouse from your health insurance coverage. Other situations that can be considered a qualifying event are a move to a different state, the birth of a child, or death of a family member. There are other situations that can qualify you for a special enrollment period, but they are more complex and vary by insurer.

Is Pregnancy a Qualifying Life Event?

A qualifying event can be any change that affects your status or eligibility for health coverage, including changes to your family size or household income, losing coverage, or pregnancy. Generally, you have 60 days after a qualifying life event to make a change to your plan.

Getting pregnant is not considered a qualifying event under the federal ACA rules, but it might be a qualifying event for New York State of Health (the state-run exchange). New York passed legislation that requires health insurers to allow pregnant women to enroll in or make plans through the marketplace during their special enrollment periods triggered by other qualifying life events.

Documents Needed to Prove Qualifying Life Event For Health Insurance

The documentation you will need to prove your qualifying life event for health insurance varies depending on the specific circumstance. For example, you will need a birth certificate or adoption papers to prove that you have a new child. You may also need a letter from your employer stating that you were terminated or laid off. Other types of proof include a marriage license, divorce papers, or a written job offer. You can also use official documents such as incarceration release, citizenship, or tribal membership papers.

If you experience a qualifying life event, you should act as soon as possible to update your health insurance. Otherwise, you will be required to wait until the next open enrollment period to make changes to your plan.