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Harbor America Resources

Exploring Qualifying Life Events

Harbor America - Jun 6, 2019, 9:37:00 AM

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While open enrollment happens only once per year, qualifying life events can occur unexpectedly, in the blink of an eye. Qualifying events, such as having a baby, losing health coverage, or becoming a citizen, can change the eligibility status for a person allowing them to enroll in health insurance coverage outside of the normal enrollment period. This period is called a special enrollment period (SLP).

A SLP is triggered by a qualifying life event and can last up to 60 days from the date of the qualifying event.

Other than those listed previously, qualifying life events can include any of the below, and more:

  • Change in coverage of the employer’s plan.
  • FMLA leave of absence
  • COBRA qualifying events, such as employment termination, reduction in employment hours, death of a covered employee, or employer bankruptcy, among others.
  • HIPAA special enrollment events, which include marriage, birth, or adoption. (Read more here.)
  • Medicare or Medicaid entitlement

Children of covered family members could lose coverage due to:

  • Turning 26 years old
  • No longer being a dependent of the covered parent or guardian
  • Death of covered parent guardian
  • Family member cutting benefits for dependents

In the event an employee experiences a life-changing event, it is important that they reach out to their human resources representative as early as possible to ensure there is little to no interruption or error in benefits.

Qualifying life events do not cover situations like the insurance carrier dropping the insured due to nonpayment or voluntarily discontinuing coverage.

It is always preferred that a person elects benefits during open enrollment, however, qualifying life events can happen, changing the person’s circumstances making their election eligibility open outside of the normal enrollment period. Contact us to learn more about qualifying life events, improving your employee benefits options, or to speak with one of our licensed administrators.

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