Qualifying Life Event For Special Enrollment: What Is It?

A qualifying life event is a change in your life when you get a special enrollment period for a health insurance plan. At the time of open enrollment each year, you can enroll and make certain alterations to your health insurance plan. Even beyond the enrollment period, you can choose a health insurance policy and make changes to it during a qualifying life event.

So which events in your life fall under the category of a qualifying life event? It can be your marriage, parenthood, or divorce as well. After any one of the events, you get an enrollment period, and this is when you choose to bring about a few changes in your health insurance policy. QLE is the popular abbreviation for a qualifying event.

How Does It Work?

Events like a marriage, childbirth, or divorce all qualify as a QLE. And the health insurance companies allow you to make changes to your policy. The period is two months. You have to contact your provider just after a life event happens to kick start the enrollment procedure. The first and foremost thing that you might have to do is prove your eligibility. Suppose Medicaid has denied you coverage and owing to that, you are forwarding your application for special enrollment.

In that situation, you might have to furnish a copy of the letter where it mentions that Medicaid has denied you coverage. If the provider asks you to prove that you are eligible for special enrollment, you will be given 30 days to prove it. Your time starts from the day of plan selection. You will be intimated about your status through notices from your provider.

Examples Of A QLE

Whenever there are changes in your job, income, family, or location, they attain the status of a qualifying life event. If the size of your household changes because of your marriage or divorce, you qualify for a QLE. Events such as weddings, separation, death in the family, etc., all fall under the category of a QLE.

Even relocation to another place like moving to a new city or a new state is a QLE. The event of health insurance loss also qualifies as a QLE. And this is if the event took place 60 days before. Or if you are applying for special enrollment within 60 days of the event.

What Does Not Qualify As A QLE

It should be clear by now that whenever you go through a life-changing situation that has a direct impact on your health insurance policy, you are eligible to make alterations to your plan. However, if you go through a situation that you think can be a QLE but does not affect your health insurance plan, the event might not be a qualifying life event.

If a divorce or a death of a family member doesn’t change your insurance coverage in any way, you won’t be eligible to apply for a special enrollment period. Going for a vacation, dropping your insurance coverage voluntarily, or cancelation your insurance owing to non-payment are all non-qualifying life events.

Complex Issues

A few unique circumstances might make you eligible for a special enrollment period. However, they might not bring around a change in the size of your household, your job, income, or location.

For instance, you might be facing domestic abuse, going through a serious medical state due to domestic violence, or encountering a natural disaster. And this could be at some stage during the enrollment period. Either of these situations can prevent you from enrolling. These situations are categorized as complex issues and undergo a review subsequently.

QLE Alternatives

If you are eligible for a special enrollment period, you can apply for CHIP, i.e., Children’s Health Insurance Program or Medicaid. In case you are not able to qualify for these. You can opt for temporary health insurance or membership health insurance.

You obtain membership health insurance when you are a member of an organization. Those who belong to the Writers Guild of America are eligible for health coverage. Short-term or temporary health insurance comes to your aid during a catastrophic event.

Temporary health insurance is not beneficial if you are looking for long-term coverage. You can also hold your patience until the time when the next enrollment period arrives. It comes at the fag end of a year.