Life Changes: When & How to Let Your Health Insurer Know – Individual Plans

Special Enrollment Period is a time outside the yearly Open Enrollment Period when you can sign up for health insurance. This is the first article in a series about this period depending on the type of health insurance you have. This article is for those who are covered by Individual Plans. In the future, we will add to the series by exploring when you are in an Employer-Sponsored Plan and Medicare.

You must experience a big life-changing situation to qualify for the Special Enrollment Period. It is important to let your health insurance provider know of any of these events. If it is a planned event, it is beneficial to let them know ahead of time. If the event is unplanned, you should let them know as soon as possible.

Following is a list of some of the life changes that most likely will qualify you for a Special Enrollment Period (Please note that this is not a complete list. If you suspect that your event qualifies you should contact your health insurance provider or employer):

• Losing existing health coverage, including job-based, individual, and student plans
• Losing eligibility for Medicare, Medicaid, or CHIP
• Turning 26 and losing coverage through a parent’s plan
• Turning 65 which gives you a chance to investigate your opportunities for a Medicare plan
• Getting married or divorced
• Having a baby or adopting a child
• Death in the family
• Moving to a different ZIP code or county if it is in a different rating area
• A student moving to or from the place they attend school
• A seasonal worker moving to or from the place they both live and work
• Experiencing a shift in employment status
• Earning U.S. Citizenship
• Moving to or from a shelter or other transitional housing

In most situations, you’ll need to make changes to your health plan within a specific time frame of the qualifying life event. You will be required to provide at least one type of written proof with specific information. Please check with a licensed broker before starting the process to make sure you have the timeline and documentation needed. Missing this deadline could mean having to wait until the next open enrollment, which could mean waiting a year.

“Not everything that is faced can be changed, but nothing can be changed until it is faced.” – James Baldwin

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