Making Sure You’re Covered: Qualifying Life Events

You’ve started a new year. You’re healthy. You have health insurance. Things are going great.

But like all things in life, things change. You find out your company is downsizing and you’ve lost your job-based health insurance. Or maybe you’re having a baby.

Thankfully, it doesn’t mean you have to worry about your insurance coverage. Loss of current health care coverage due to job loss and having a baby are both qualifying life events that provide a Special Enrollment Period to get individual health insurance outside of the once-yearly open enrollment period.

What Is A Qualifying Life Event?

chocolate cake with sparklers

Turning 26 and no longer eligible to be on your parent’s plan

woman on laptop rubbing eye

Losing your current health care coverage

smiling newly weds

Getting married

couple on couch having disagreement

Losing coverage through a divorce

man on phone and looking at laptop

Losing eligibility for Medicaid or Children’s Health Insurance Program (CHIP)

closeup of child hugging moms pregnant belly

Having a baby, adopting a child or placing a child for foster care

closeup of couple holding hands sitting in car

Retiring, eligible for Medicare and Medicare Supplement

closeup of hand holding toy house

Moving outside your insurance plan’s area

Limited Time Frames to Make Health Insurance Changes

These events provide you a short window of time — usually about 60 days from when your coverage ends — to enroll in a new plan or change the existing plan in your household. This includes a spouse who has coverage through a different employer.

Unlike the yearly open enrollment period, documentation is typically necessary to verify your change in status, said Janice Lewis, Sales Associate with Avera Health Plans. This can depend on the event, but can include a birth certificate, marriage certificate or certificate of creditable coverage from your previous insurance plan.

While there is that short window to make changes after a qualifying life event, it’s best to call right away to alert your plan in case you need to track down necessary documentation.

“People sometimes don’t understand that the open enrollment period is the only time they are allowed to enroll without a qualifying life event,” Lewis said. “Unfortunately, when people call wanting health insurance coverage at another time throughout the year, we have to tell them that they must wait until the next open enrollment period in the fall — unless they have a qualifying life event.”

Health Insurance for College Students

Kids can stay on their parents’ plan until they’re 26 years old. But what if they head to college out of the network? Depending on your coverage, students may be able to join an affiliated network where they are enrolled. Avera Health Plans offers this option to its members with a few easy steps. Here’s what to do:

  1. Call the Service Center to report where your student will be living and enrolled.
  2. Avera Health Plans will verify enrollment and find an affiliated network in your area.
  3. You’ll receive a card with your student’s in-network information.
  4. Search providers and hospitals inside the network — it’s not guaranteed that all health systems and providers in your child’s town will be included.

Tip: Make the call at the beginning of the school year so you can get the network set up before your child needs to see a doctor.

Agent with Couple