Talking the insurance way, any life event can influence your insurance coverage, especially in health insurance. In other words, your health insurance coverage can vary with changes in your personal and professional life. These are QLEs or qualifying life events. So, what is QLE, and what should you know about it?
According to the Affordable Care Act, in most states, you purchase health insurance during the annual open enrollment period from Nov 1 to Jan 15. However, one can certainly purchase health insurance outside the open enrollment period if they come under qualifying life events.
What are qualifying life events?
QLEs are those significant moments in life that allow you to change your health insurance outside the typical enrollment period. Therefore, these events must impact you in such a way that it demands a change in the existing coverage.
Examples of Qualifying Life Events
Losing health coverage
A person can lose health coverage if the premiums are not paid on time. However, it will not be a reason to consider it a QLE. Here are a few situations where losing health coverage can be classified as a qualifying life event.
- Losing eligibility for an eligibility program.
- If you’ve lost the coverage through your parent’s plan.
- You’ve quit a job and hence lost the coverage.
Changes in your status
Your marital status and the possible developments that can happen with it will qualify as a QLE.
- Marriage or divorce.
- New child, adoption, or adding more dependents.
- If you have lost coverage due to a death in the family.
Change in place of stay
Any changes that influence your place of residence are a qualifying life event.
- If you have moved states.
- Change in schools in the case of students.
- Place of work and stay has changed.
In addition to these, there are other QLEs. For instance, becoming a US citizen, release from prison, job change, or retirement of a spouse are also classified as qualifying life events.
Why are QLEs important for health insurance?
- It makes sure that there is continuous coverage even during major life events.
- They provide the flexibility to adjust coverage, add or remove dependents, and explore new plans that better align with changing circumstances.
- QLEs give access to the special enrollment period.
- QLEs recognize the events and allow individuals to make appropriate changes to their coverage.
How do I update your health insurance after qualifying for a life event
Normally, QLEs start a special enrollment period (SEP) where you can modify your health insurance. However, the timeline is when they recognize the precise timeline that you must take action.
Firstly, contact your health insurance provider or the entity responsible for managing your insurance plan. Secondly, provide the required documentation related to the qualifying life event. For instance, marriage or divorce certificates, birth or adoption certificates, proof of loss of coverage, proof of residency change, or any other documentation specific to your situation. Thirdly, evaluate the options based on your new circumstances and update your health insurance. Consequently, complete the enrollment procedure and confirm the effective date of your updated coverage.
Can I find health insurance if I don’t have a qualifying life event?
You could still find affordable health coverage if you do not have a QLE or missed enrollment. These include COBRA coverage, short-term health insurance, and Medicaid.
COBRA Coverage
Consolidated Omnibus Budget Reconciliation Act or COBRA insurance allows you to keep the existing health insurance even if you have lost your job. Therefore, you don’t start a new health plan; instead, you pay the premiums for the existing plan. However, COBRA can be expensive.
Short-term Coverage
This is a temporary setup for those who are changing jobs. In addition to bridging the coverage gap that may arise, it also comes with low premium rates. However, the benefits are limited.
Medicaid
Medicaid is a government program in the United States that provides healthcare coverage to eligible low-income individuals and families. However, you should meet the income criteria to qualify for Medicaid.
QLEs are essential for health insurance because they enable individuals to adapt their coverage to major life events, maintain continuous coverage, access special enrollment periods, and protect against unforeseen circumstances.
