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Qualifying Life Events For Health Insurance

Understanding Qualifying Life Events and Health Insurance


There are times when life changes unexpectedly. And when it does, those changes may occur outside the yearly Open Enrollment Period. To accommodate the unexpected, Special Enrollment Periods ensure you always receive essential health insurance coverage during qualifying life events.


To make sure you have the opportunity to purchase coverage during those times, a Special Enrollment Period allows you to enroll in essential health insurance coverage during qualifying life events. 

What Is A Qualifying Life Event?


Certain changes in your life situation are known as qualifying life events – things like a loss of health coverage, a change in your household, or a change in residence. These qualifying events give you the opportunity to sign up for a new health insurance plan or change an existing health insurance plan outside the Open Enrollment Period.


Qualifying life events typically include, but are not limited to:

  • Becoming newly married or divorced.

  • Having a baby or adopting a child.

  • Experiencing a death of the insurer in the family.

  • Losing health insurance coverage due to job loss.

  • Losing eligibility for Medicare, Medicaid, or Children’s Health Insurance Program (CHIP).

  • Turning 26 and losing coverage from your parent’s health insurance plan.

  • Moving to a different zip code or county that changes your health plan area.

Because every situation is different, you may need to present documentation to show how the life event impacts your health insurance coverage. 


How A Qualifying Life Event Works


Your health insurance provider gives you the chance to make changes to your health insurance plan typically up to 60 days after a qualifying life event. These exceptions help you make necessary updates to your health insurance coverage due to special circumstances. To determine your eligibility for a qualifying life event, notify your health insurance provider as soon as these circumstances happen.


What Kind Of Documents Do I Need For A Qualifying Life Event?

Documentation often depends on the event and could include:

  • Birth certificates, adoption records, and marriage licenses that show you have added family members and need to modify your health insurance coverage.

  • Divorce papers or death certificates that show family members who provided health insurance have left you without coverage.

  • New rental agreements or mortgages that show you have moved into a new health insurance plan area.

These are just a few of the types of documents you may need. If you think you are experiencing a qualifying life event, speak to your health insurance provider to see what documents might be necessary for eligibility.


What If I Do Not Qualify For A Special Enrollment Period?


Some life-changing events are not considered a qualifying life event. But you have options if you do not qualify. For example, you may be able to:

  • Apply for Medicaid. If you need health insurance and qualify, Medicaid accepts applications year-round.

  • Apply for alternative health insurance solutions. Specialized health insurance plans like Anthem Enhanced Choice1 are designed to provide coverage during changing life situations. The plans provide comprehensive coverage and are not restricted by enrollment periods.

You deserve to feel confident that your health is covered and protected when you have a life-changing event. Qualifying events for insurance are not always clearly defined. That’s why Anthem is here to help you understand if your life event changes your health insurance coverage and any options you have. Anthem can help you review your best options for consistent health plan protection through all of life’s changes.


1Anthem Enhanced Choice coverage is not required to comply with certain federal market requirements for health insurance, principally those contained in the Affordable Care Act. Be sure to check your policy carefully to make sure you are aware of any exclusions or limitations regarding coverage of preexisting conditions or health benefits (such as hospitalization, emergency services, maternity care, preventive care, prescription drugs, and mental health and substance use disorder services). Your policy might also have lifetime and/or annual dollar limits on health benefits. If this coverage expires or you lose eligibility for this coverage, you might have to wait until an open enrollment period to get other health insurance coverage.

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