Outside of open enrollment, you can still enroll or switch to a different plan if you have a qualifying life event that triggers your own special enrollment period (SEP) window. A SEP will give someone a limited window to newly enroll or to switch to a different plan, depending on the circumstances. There’s a lengthy list of qualifying life events that make employees eligible for special enrollment, and this guide will walk you through all the qualifying life events and the specific rules for how they trigger special enrollment periods.
Please note: In many cases, a SEP is only available if an employee already had minimum essential coverage prior to the qualifying life event.
What is a qualifying life event for health insurance?
A qualifying life event is a life-changing situation that can impact you and your health insurance. Experiencing a significant life change may allow you to change your health plan outside of Open Enrollment.
Qualifying life events include (but are not necessarily limited to)
- Getting married or divorced
- Having or adopting a baby
- Death of someone who shares your health plan
- Moving to a new area
- Earning U.S. citizenship
- Turning 26
- Becoming Medicare-eligible
- Experiencing a shift in employment status
- Loss of health insurance
A full list of qualifying life events can be found at healthcare.gov (External Site)
If you’ve experienced a qualifying life event, contact the UMS Employee Benefits Center. Here are 3 important things to know:
- Timing: Changes must be made within 31 days of the date of event.
- Don’t miss the deadline: If you miss this deadline, you may have to wait until the next open enrollment period, which could be as long as a year.
- Documentation: You may need to submit documents to confirm your qualifying life event.
