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You are here: Home / Qualifying Life Events and Special Enrollment Periods

Qualifying Life Events and Special Enrollment Periods

Qualifying Life Events (QLE’s) are exceptions that allow you to enroll in or change your health insurance plan outside the yearly Open Enrollment Period. That is a Special Enrollment Period. If you experience certain types of life changes, a QLE, like losing health coverage, getting married, or having a baby;  you may qualify for a Special Enrollment Period to enroll in a Marketplace plan for the rest of 2017.

The definitions are very specific:

1. You lost your health insurance

Did you or anyone in your household lose qualifying health coverage in the past 60 days OR expects to lose coverage in the next 60 days.

  • Lost job-based coverage
  • Lost COBRA coverage
  • Lost individual health coverage for a plan or policy you bought yourself
  • Lost eligibility for Medicaid or CHIP
  • Lost eligibility for Medicare
  • Lost your coverage through a family member (such as often happens in divorce)

2. Your Household Changed Size

This means you or anyone in your household in the past 60 days:

  • Got married. Pick a plan by the last day of the month and your coverage can start the first day of the next month.
  • Had a baby, adopted a child, or placed a child for foster care. Your coverage can start the day of the event — even if you enroll in the plan up to 60 days afterward.
  • Got divorced or legally separated and lost health insurance. Note: Divorce or legal separation without losing coverage doesn’t qualify you for a Special Enrollment Period.
  • Death. You’ll be eligible for a Special Enrollment Period if someone on your Marketplace plan dies and as a result you’re no longer eligible for your current health plan.

3. Moved or changed your residency

Moves that qualify are:

  • Moving to a new home in a new ZIP code or county
  • Moving to the U.S. from a foreign country or United States territory
  • A student moving to or from the place they attend school
  • A seasonal worker moving to or from the place they both live and work
  • Moving to or from a shelter or other transitional housing

Note: Moving only for medical treatment or staying somewhere for vacation doesn’t qualify you for an SEP.

Important: You must prove you had qualifying health coverage for one or more days during the 60 days before your move. That means providing your bills and receipts for payment of premiums, or a letter from the insurance provider. You don’t need to provide proof if you’re moving from a foreign country or United States territory.

4. Other qualifying changes

Other life circumstances that may qualify you for a Special Enrollment Period:

  • Changes that make you no longer eligible for Medicaid or the Children’s Health Insurance Program (CHIP)
  • Gaining membership in a federally recognized tribe or status as an Alaska Native Claims Settlement Act (ANCSA) Corporation shareholder
  • Becoming newly eligible for Marketplace coverage because you became a U.S. citizen
  • Leaving prison, jail or other legal incarceration
  • AmeriCorps VISTA members starting or ending their service

Learn about Special Enrollment Periods for complex issueshttps://www.healthcare.gov/sep-list/.

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