If you’ve missed the Open Enrollment Period for health insurance, you may still have options to obtain coverage through a Special Enrollment Period (SEP). SEPs are triggered by Qualifying Life Events (QLEs), which are significant changes in your personal circumstances. These events allow you to enroll in or modify your health insurance plan outside the standard enrollment window.
Understanding Qualifying Life Events (QLEs):
A QLE is a change in your situation—such as getting married, having a baby, or losing health coverage—that can make you eligible for a Special Enrollment Period, allowing you to enroll in health insurance outside the yearly Open Enrollment Period.
There are four basic types of qualifying life events according to HealthCare.gov:
- Loss of Health Coverage:
- Losing existing health coverage, including job-based, individual, and student plans.
- Losing eligibility for Medicare, Medicaid, or the Children’s Health Insurance Program (CHIP).
- Turning 26 and losing coverage through a parent’s plan.
- Changes in Household:
- Getting married or divorced.
- Having a baby, adopting a child, or placing a child for foster care.
- Death in the family.
- Changes in Residence:
- Moving to a new ZIP code or county.
- A student moving to or from the place they attend school.
- A seasonal worker moving to or from their work location.
- Moving to or from a shelter or other transitional housing.
- Other Qualifying Events:
- Changes in your income that affect the coverage you qualify for.
- Gaining membership in a federally recognized tribe or status as an Alaska Native Claims Settlement Act (ANCSA) Corporation shareholder.
- Becoming a U.S. citizen.
Special Enrollment Period (SEP):
A Special Enrollment Period is a time outside the yearly Open Enrollment Period when you can sign up for health insurance. You qualify for a Special Enrollment Period if you’ve had certain life events, including losing health coverage, moving, getting married, having a baby, or adopting a child, or if your household income is below a certain amount.
Employer Notification and Timeframes:
If you experience a QLE, it’s crucial to act promptly. Typically, you have a 60-day window from the date of the event to enroll in a new health insurance plan. However, for employer-sponsored plans, this window may be shorter, often 30 days. Therefore, it’s essential to notify your employer (or your Professional Employer Organization, if applicable) within this timeframe to make new benefit elections.
Examples of QLEs in Detail:
- Marriage: Getting married allows you to add your spouse to your existing health plan or enroll in a new one. It’s important to report this change promptly to ensure coverage for your spouse.
- Loss of Coverage: If you lose health insurance due to a job loss, losing eligibility for Medicare, Medicaid, or CHIP, or aging out of a parent’s plan at 26, you qualify for an SEP to obtain new coverage.
- Change in Residence: Moving to a new area where different health plans are available can trigger an SEP, allowing you to select a plan that suits your new location.
Action Steps:
- Assess Your Situation: Determine if your life event qualifies as a QLE.
- Notify Your Employer or PEO: Inform them within the required timeframe (usually 30 days) to adjust your benefits accordingly.
- Explore Your Options: Review available health plans to choose one that fits your needs and circumstances.
Understanding QLEs and SEPs ensures that you maintain continuous health coverage, even if you’ve missed the Open Enrollment Period. By acting swiftly after a qualifying event, you can secure the necessary health insurance for yourself and your dependents.
How HRDelivered Helps
Are you confident your current provider offers the guidance and support needed to handle these changes seamlessly? At HRDelivered, we simplify the process, providing personalized assistance to ensure your team is covered year-round—reach out to discover how we can help!
