Qualifying Events- What Are They?

qualifying events

Qualifying Events- What Are They?

Your client’s life will not stay the same forever. Whether they get married, gain a new family member, or lose one, they will need to adjust their current health insurance plan. Luckily, there is a special enrollment period (SEP) that they may be eligible for when these changes, otherwise known as qualifying events, happen.

Qualifying events can come in any of these ways- loss of coverage, a change in the household, or a change in residence. More specifically, though, they can include:

  • Marriage or divorce
  • Adoption or having a baby
  • Relocation to a city or county that changes their health plan area
  • Job loss which leads to lost health coverage
  • Lost eligibility for Medicaid, Medicare, CHIP
  • Death of insurer of family
  • Turning 26 and being removed from parents’ health plan

Your client’s health insurance provider should give them about 60 days after the qualifying event to make the necessary changes to their health plan. To find out if they are eligible, they need to inform their health insurance provider of any of these circumstances.

There are a few extra steps and some documentation that may be asked for to prove eligibility. This paperwork can include:

  • A marriage license, birth certificate, adoption record- something to prove that there are additional family members and a need for new coverage
  • A death certificate, or divorce papers- to show that there is a loss of family and a need for adjusted coverage
  • Mortgage papers or rental agreement- shows a relocation where they might need a new health plan

These are just some examples of documentation that is needed to confirm eligibility. However, it is always best for your client to check with their health insurance provider to get an accurate picture of what is necessary.

Not every life change will be considered for a special enrollment period. However, there is no need to worry because there are other options. Your client can always apply for Medicaid. Medicaid accepts applications all year round, so it is perfect for a client that qualifies and needs health insurance. Another option would be to find a different plan that does not need to stick to certain enrollment periods.


We hope this information on qualifying events is helpful to you.

Empower Brokerage is dedicated to helping you educate your clients on the insurance they need and staying on top of their health. Whether it’s through webinar training, one-on-one calls, seminars, or marketing plans. We want you to be successful. Give us a call if you have any questions 888-539-1633.

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