What is a Qualifying Event and Why Does It Matter?

The terms Qualifying Event, Special Enrollment Period, and Open Enrollment Period get tossed around in conversation when discussing both employer-sponsored benefits and individual health insurance plans.

The timeframes in which you can alter your benefits through a company or for your own individual policy are limited to certain times or events of the year. For employer-provided benefits, the time of year to make changes, add, or remove coverage for yourself and family members is called open enrollment and is managed by Human Resources. It’s “open” because these adjustments are made at the employee’s discretion. If you purchase your own health insurance through a private insurance company or the Health Insurance Marketplace (Obamacare), open enrollment takes place each year starting November 1st and ending December 15th. Any changes from this timeframe go into effect as of January 1st the following year. Outside of these timeframes, your benefits are locked in until the next enrollment period. But what happens if you need to make changes at another time due to a qualifying event?

What is a Qualifying Event?

A Qualifying Event is a life circumstance that allows someone to make changes to their insurance coverage outside of open enrollment for both employers and individuals. A Qualifying Event is a reason to have a Special Enrollment Period or midyear change. The allowed timeframe for reporting these changes or updating coverage is between 30-60 days from the date of the event. If you have missed this timeframe, you may not be allowed to make changes. Some examples of qualifying events are birth, marriage, divorce, or loss of other coverage. If you have questions on your own coverage or coverage through an employer, we are here to help!

What is a Qualifying Event and Why Does It Matter - Shield Insurance Agency Blog