Open Enrollment ended on December 15th for coverage starting January 1st. If you missed Open Enrollment, you can still get coverage this year if you experienced a Qualifying Life Event. Qualifying Life Events are specific circumstances which allow you to enroll in coverage after the Open Enrollment period. Without one of these special circumstances, getting a health insurance plan mid year can be difficult.

Individual and Family Plan Qualifying Life Events

The Affordable Care Act changed how people get health insurance throughout the year. As a result, there are many different rules for mid-year enrollments. CMS, a federal entity that oversees the insurance exchange, released this notice outlining the rules relating to mid-year applications. The main Qualifying Life Events people usually experience are:

  • Involuntary loss of minimum essential coverage. (An involuntary loss of coverage cannot be caused by non payment.)
  • Getting Married or Divorced.
  • Had a baby, adopted a child, or placed a child up for foster care.
  • Permanent change in residence from a different state or country.
  • Your employer offers an ICHRA Health Plan and you are newly eligible for coverage.

 

 
Most Qualifying Life Events require you to apply within 60 days of the event. For example, if you moved to Nevada 5 months ago, you will not be able to apply with this Qualifying Life Event since your permanent change of residence occurred over 60 days ago.

Paperwork Requirements

Submitting an application with one of these Qualifying Life Events can be easy, but proving it and submitting the right documentation can be difficult. Depending on your circumstance, the insurance company may ask for multiple forms of documentation to approve your Qualifying Life Event. For example, you will need to send in a Marriage Certificate to prove you married in the past 60 days. Therefore, it is important to have your documentation ready to submit so you can finalize the enrollment promptly. Most insurance companies give you a 30 day deadline to submit these documents.

Since there are so many requirements with these types of enrollments, we recommend that you consult one of our licensed brokers to understand what needs to be submitted. We will also help you through every step of the process to make sure the insurance company approves your application.