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Published on March 28, 2016

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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.

Other events that qualify include marriage, divorce and moving. 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, including a spouse who has coverage through a different employer.

Check out this infographic for other life events »

Time Is Limited

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 depends on the event, but can include a birth certificate, marriage certificate or certificate of coverage from your previous insurance plan.

While qualifying life events are not new to employer-based programs, the creation of an open enrollment period through the Affordable Care Act means people are more limited in when they can sign up for an individual or family insurance plan the rest of the year.

“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.”

While there is that short window to make changes after a qualifying life event, it’s still best to call right away to alert your plan in case you need to track down necessary documentation, Lewis advises.

College Bound

One recent change to health insurance regulations is that 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

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