An HR Glossary for HR Terms

Glossary of Human Resources Management and Employee Benefit Terms

Qualifying Life Event

A qualifying life event, as far as health insurance goes, is a change in situation (such as getting married or divorced, a change in residence, or a job loss) which makes a person eligible to enroll in health insurance outside of the yearly Open Enrollment Period.

What Is a Qualifying Life Event for Health Insurance?

A Qualifying Event for health insurance purposes is a major event that affects a person’s health insurance needs, and qualifies that person to make changes or buy a health plan immediately, even if it’s outside of open enrollment dates.

Generally, Special Enrollment lasts 60 days before or after the qualifying event takes place and allows an individual to immediately make plan changes or sign up for a new coverage.

What Is a Qualifying Life Event?

An event that takes place which makes someone eligible for a health insurance Special Enrollment Period, rather than waiting for an Open Enrollment Period, is called a Qualifying Life Event.

There are four categories of qualifying life events:

  1. Loss of health insurance
  2. Changes in household
  3. Changes in residence
  4. Other qualifying changes

Loss of Health Insurance

Changes in Household

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Changes in Residence

Other Qualifying Changes

In addition to the above-mentioned qualifying life events, there are times when an Exceptional Circumstance (also called Special Circumstance) takes place that may qualify a person for a Special Enrollment Period.

Special Enrollment Period Examples:

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Is Getting Pregnant a Qualifying Life Event?

No, getting pregnant is not a qualifying life event for a special enrollment period in the marketplace. However, giving birth, adopting a child, or having a foster child placed in your home are qualifying life events.

Is a New Job a Qualifying Event?

No, getting a new job is not considered a qualifying event for special enrollment. However, gaining new employment may trigger a special enrollment period for the group coverage at the new job, should the employer offer it. Picking up employer-based coverage will trigger a disenrollment period for other coverage.

How Long Do You Have For a Qualifying Event?

A special enrollment period generally lasts 60 days before or after the qualifying event and allows an individual to make plan changes or sign up for a new health insurance plan immediately.

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