A Qualifying Life Event (QLE) is an event that happens that makes you eligible to change your health care plan outside of the annual enrollment period. Usually, the annual “Open Enrollment” period is at the end of the year, right before the start of the plan for the next year. For health plans on healthcare.gov, open enrollment is typically from November 1st to January 15th of the next year.
If you are insured by a private employer though, your open enrollment dates may be shorter and may vary. Outside of these dates, you may not make changes to your health care plan, unless you have a qualifying event that triggers what is called a Special Enrollment Period (SEP).
What counts as a Qualifying Life Event (QLE)?
Changes in your job or loss of a job
This is probably the most frequent qualifying event that happens for people in the workforce. Losing employer-sponsored coverage or gaining access to new options typically qualifies you for a Special Enrollment Period, allowing you to update your benefits. If you change jobs, you may no longer be eligible for your last company’s healthcare insurance, so you’ll have to switch to your new company’s. Usually, onboarding at a new job will help you take care of this. If you quit your job, or are laid off, you may need to elect to sign up for COBRA coverage that your former job provides or find an alternative healthcare plan on the government exchange.
Offering of a NEW health benefit
Similarly to changing jobs, if your employer decides to change to a new health benefit offering, such as ICHRA or QSEHRA, all employees will qualify for a Special Enrollment Period. If this happens, your company will help you understand the changes and help everyone onboard the new plan. You may also be eligible for a Special Enrollment Period to buy coverage outside of what your company offers if you reject the HRA coverage, or if the coverage offered by your employer doesn’t meet minimum standards for “affordability”.
Learn more about HRA options with Benafica.
Changes in your household
Big moments at home — like getting married, having a baby, adopting a child, or a death in the family — can affect your healthcare coverage. Qualifying changes in household include:
- Getting married
- Getting a divorce or legal separation (that causes you to lose health insurance)
- Having a baby, adopting a child, or placing a child in foster care
- Death of a spouse or dependent (that results in a loss of your health insurance)
Changes in your residence
Moving can be a qualifying event, but it needs to be within certain parameters. Moving to a new zip code or county can impact the plans available to you and coverage networks. Here’s when you can take advantage of health insurance changes if you’ve:
- Moved to a new zip code or county
- Moved to the United States from a foreign country or territory
- Moved to the place you attend school (if you’re a student)
- Moved to the place you both live and work (if you’re a seasonal worker)
- Moved to a shelter or other transitional housing
Other Situations
Some life events are less common but still count: changes in immigration status, gaining or losing eligibility for Medicaid or Medicare, or a change in your income that affects subsidy eligibility. Here are some rare situations that might allow you to change or update your health insurance plan:
- Becoming a US citizen
- Leaving incarceration
- Starting or stopping service as an AmeriCorps State and National, VISTA, or National Civilian Community Corps (NCCC) member
- Experiencing an unexpected or uncontrollable event like a natural disaster.
How long to I have to update my coverage after experiencing a qualifying event?
In most cases, you have a 60-day window after the qualifying event to update your coverage. If you miss this deadline, you may have to wait until the next Open Enrollment period to make changes. Acting quickly ensures you maintain the coverage you need without a gap in benefits.
For more about Qualifying Life Events and Special Enrollment Periods, see healthcare.gov.