congrats-candlesThere are many exciting events that occur during your life. New baby, marriage, becoming an American citizen – these are times to celebrate! We get so caught up in life’s happy moments that we can forget about making important adjustments to our individual health insurance policy. After all, that is not the first thing we think of on our wedding day.

Of course, there are other major events in a person’s life that also call for a health insurance policy update. These events can also be all-encompassing so updating your policy again may not be top of mind. Things like termination or reduced work hours, death, divorce, even exhausting COBRA coverage all warrant an adjustment to individual health insurance policies.

Life’s Events Call for Special Enrollment

Because we simply cannot predict everything and frankly are unable to plan our lives around open enrollment periods, individual policies allow for special enrollment to accommodate the unforeseen. The special enrollment extends to the Affordable Care Act Marketplace as well.

Qualifying events are those types of circumstances that are beyond your control, such as the birth of a child, or marriage or divorce. These types of events cannot be scheduled around open enrollment, so special dispensation is given to allow for you to make appropriate adjustments to your individual health insurance policy based on need.

Examples of qualifying events include:

  • Marriage or Divorce
  • Loss of HMO Coverage
  • Loss of MEC (Minimal Essential Coverage)
  • Exhausting COBRA Coverage
  • Employer Ceasing to Contribute to Employee or Dependents Coverage
  • Dependent Aging Off Policy
  • Death
  • Termination or Reduced Work Hours

If possible, plan ahead and speak to your health insurance benefits specialist  to prepare for the changes needed to your individual health insurance policy.

With regard to special enrollment for the Federal or State Marketplace, you can qualify if one of the following applies:

  • Qualifying Life Event – much like the scenarios discussed above, these life events include having a baby, getting married or losing other coverage.
  • Other Complicated Cases – these are thoroughly outlined on the site, but include:
    • Exceptional circumstance, such as a serious medical condition or natural disaster that kept you from enrolling.
    • Misinformation or misrepresentation, such as misconduct by a non-Marketplace enrollment assister (like an insurance company, navigator, agent or broker) that kept you from being enrolled or enrolled in the correct plan.
    • Enrollment error
    • System errors related to immigration status
    • Display errors on

For more information and details, see the website.

Life’s Little Events Call for Coverage

Whether the event is a happy occasion or a circumstance beyond your control, it is good to know that you can at least take control of your individual health insurance policy by making appropriate adjustments via the special enrollment process. If you have questions regarding qualifying events, or simply want to know more, please contact one of our health insurance benefits specialists who will be glad to assist you in answering your questions.

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