Special Enrollment Period Qualifying Life Event
A change in your situation — such as getting married, having a baby, or losing health coverage — that can make you eligible for a Special Enrollment Period, enabling you to enroll in health insurance outside the yearly Open Enrollment Period.
Here is a documentation of the life of qualifying life events.
- Loss of health insurance coverage
You may be qualified for a Special Enrollment Period if you or any person in your household lost qualifying health coverage in the past 60 days OR expects to lose coverage in the following 60 days.
- Losing existing health coverage, as well as job-based, individual, and student health insurance plans.
- Losing eligibility for Medicare, Medicaid, or the Children’s Health Insurance Program (CHIP).
- Turning 26 years and losing coverage through a parent’s health insurance plan
- Changes in household
- Getting married or divorced. Divorce without losing coverage does not qualify you for a Special Enrollment Period.
- Having a child or adopting a child. Your coverage can begin the day of the event — even if you enroll in the plan up to 60 days later.
- Death in the household. You will be qualified for a Special Enrollment Period if someone on your Marketplace plan dies, and as a result, you are no longer qualified for your current health plan.
- Changes in residence
- Moving to a different ZIP code or nation.
- A learner moving to or from the place they attend school
- A seasonal employee moving to or from the place they both live and work
- Moving to or from a shelter or other provisional housing
- An employer offers to assist with the cost of coverage
You may be eligible for a Special Enrollment Period if you or any person in your household newly gained access to an individual coverage HRA or a Qualified Small Employer Health Reimbursement Arrangement (QSEHRA) in the past 60 days or anticipates to in the next 60 days.
Note: Your employer may refer to an individual coverage HRA by a different name, such as the acronym “ICHRA.”
In general, you will require applying for and enrolling in individual health insurance before your coverage HRA or QSEHRA begins. Though your employer may offer different options for when your individual coverage HRA or QSEHRA can begin, so you have more time to enroll. Contact them or check the notice you got from your employer for additional information. If you are presently enrolled in a Marketplace plan with savings, these savings may change because of the support you get through a job.
- Other qualifying situations
- Changes in your income that impact the coverage you qualify for a special enrollment.
- Acquiring membership in a federally recognized tribe or status as an Alaska Native Claims Settlement Act (ANCSA) Corporation shareholder.
- Becoming a United States citizen
- Leaving detention (jail or prison)
- AmeriCorps members beginning or ending their service
Resources and References: