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Published on September 01, 2020

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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. Or maybe you’re having a baby.

Thankfully, it doesn’t mean you have to worry about your insurance coverage. Loss of a job 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?

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

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Losing your job-based plan

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Getting married

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Losing coverage through a divorce

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

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

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Retiring, eligible for Medicare and Medicare Supplement

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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, Lewis advises.

“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.

Learn more about qualifying life events at AveraHealthPlans.com.

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Avera is a health ministry rooted in the Gospel. Our mission is to make a positive impact in the lives and health of persons and communities by providing quality services guided by Christian values.

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