A Helpful Tool for Those with Clients Wishing to Enroll Outside AEP
As we’ve mentioned before, individuals may be able to apply for coverage outside of open enrollment if they, or someone in their family, has a qualifying life event.
A listing of some examples of common qualifying life events. While not a complete list, the chart does include some common examples and other information that may be useful.
|Qualifying Event||Definition||Application Deadline||Effective Date|
|Loss of coverage||Individual or his/her dependent loses minimum essential coverage (for example, through loss of a job.) Voluntarily dropping coverage is not considered loss of coverage.||Within 60 days of event||First day of the month following application submission|
|Marriage||Individual gains or becomes a dependent due to marriage.||Within 60 days of event||First day of the month following application submission|
|Birth or adoption||Individual gains or becomes a dependent due to birth, adoption, or placement for adoption / foster care.||Within 60 days of event||Date of birth, adoption or placement for adoption|
|Moving||Individual or his/her dependent gains access to additional plans as a result of a permanent move.||Within 60 days of event||Normal effective date **|
|Divorce from policyholder||Individual loses coverage as a result of divorce.||Within 60 days of divorce||First day of the month following application submission|
|Error in enrollment||There was an error in the enrollment process for the individual or his/her dependent’s current plan (as defined in federal law.)||Within 60 days of event||Date of the event|
|Error in policy||Individual or his/her dependent’s plan or issuer substantially violated a material provision in a current plan.||Within 60 days of event||Date of the event|
|Return from active military service||Individual is newly eligible due to return from active military service.||Within 60 days of event||First day of the month following application submission|
* This is not a complete list. There may be other events that apply. Some qualifying events apply on Exchange only.
** Normal effective date: When an application is received between the first and the fifteenth day of any month, the effective date will be the first day of the following month; when an application is received between the sixteenth and the last day of any month, the effective date will be the first day of the second following month.
Qualifying life events are defined in federal law.