Qualifying life events
What is a qualifying life event for health insurance?
A qualifying life event is a life-changing situation — sometimes planned, sometimes unexpected — that can impact you and your health insurance. Experiencing a significant life change may allow you to change your health plan outside of the annual enrollment period (also called open enrollment).
If you’ve experienced a qualifying life event, check your plan materials, contact your employer or call the phone number on your member ID card for help.
Qualifying life events include (but are not necessarily limited to):1
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Getting married
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Getting divorced
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Having or adopting a baby
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Death of someone who shares your health plan
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Moving to a new area
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Earning U.S. citizenship
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Turning 26
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Turning 65
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Experiencing a shift in employment status
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Loss of health insurance
How do I qualify for a special enrollment period?
If you experience any qualifying life event, you’d qualify for a Special Enrollment Period (SEP). That means you can enroll in a health plan outside of the annual enrollment period. Sometimes, SEPs are offered for other qualifying reasons, such as natural disaster relief, pandemic relief or because of a public health emergency.
Medicaid renewal
If you’re no longer eligible for Medicaid, that also means you qualify for a special enrollment period (SEP).
How do I enroll in a plan after a qualifying life event?
If you’ve experienced a qualifying life event, check your plan materials, contact your employer or call the phone number on your member ID card. Here are 3 important things to know:
- Timing: Changes can most often be made either 30 or 60 days after the life event happens
- Don't miss the deadline: If you miss this deadline, you may have to wait until the next open enrollment period, which could be as long as a year
- Documentation: You may need submit documents to confirm your qualifying life event. See document list
Types of qualifying life events
Here’s a little more about each type of qualifying life event.
When you experience a major shift in your family life, your benefits may also need to change. Family changes that count as qualifying life events include:
- Getting married
- Bringing children into the family with the birth of a baby, adoption or foster care
- Divorce
- Death of a member enrolled in your health plan
If you've experienced one of these qualifying life events, call the phone number on your member ID card to learn about your options.
When it comes to health insurance, turning 26 is a milestone birthday — it’s time for the baby birds to “leave the nest” of their parents’ health insurance and find their own plans.
If you just turned 26, call the phone number on your member ID card to learn about your options.
Another change that can affect special enrollment eligibility is moving. It could be that you’re relocating to an area where your current coverage isn’t available. Or, you might be moving to an area where your current coverage is available, but there are new plans to consider.
If you've recently moved, call the phone number on your member ID card to learn about your options.
A change in employment status — whether voluntary or involuntary (laid off, dismissed, resigned, quit or retired) — is another qualifying life event.
If you've experienced a job change, call the phone number on your member ID card to learn your options. COBRA may be one of the options you may consider.
If you lose your insurance, it's considered a qualifying life event.
This means if you lost your health insurance in the past 60 days or if you expect to lose your coverage in the next 60 days, you may qualify for a Special Enrollment Period (SEP). This includes:
- Medicaid or Children's Health Insurance Program (CHIP) coverage
- Job-based coverage
- Individual health coverage
- Eligibility for Medicare
- Coverage through a family member
If you are asked to renew or recertify your Medicaid (also called redetermination) and you lose your Medicaid coverage, you may qualify for a Special Enrollment period.
Are you turning 65?
Turning 65 is another moment in time that’s a qualifying life event. It gives you a chance to look into your opportunities to choose a Medicare plan.
Medicare, a federal program, serves as the primary source of health insurance for those 65 and older (or those under 65 who may qualify for benefits because of a disability or other circumstance).
To find out who is eligible for Medicare, what you should do if you choose to work past 65, who can enroll in Original Medicare (Parts A and B) or how to apply for more coverage, you can look into Medicare basics.
There are four categories, or parts, of Medicare:
- Part A: Medicare Part A covers hospital insurance — inpatient hospital stays, care in a skilled nursing facility, hospice care and some home health care.
Learn more about Medicare Part A - Part B: Medicare Part B covers certain medical insurance — doctors' services, outpatient care, medical supplies and preventive services.
Learn more about Medicare Part B
Parts A and B are sometimes referred to as Original Medicare, and they don’t cover everything. Services like dental work, vision exams/eye care and out-of-pocket costs, including deductibles, are not covered.
- Part C: (Medicare Advantage): Medicare Part C/Medicare Advantage is a private health plan combining hospital and medical insurance, plus the potential for additional health benefits.
Find a Medicare Advantage Plan that may be right for you
Learn more about UnitedHealthcare Medicare Advantage (Part C) plans - Part D: Medicare Part D plans, offered by insurance companies approved by Medicare, add prescription drug coverage to Original Medicare and Medicare supplement insurance plans.
Find a Medicare Prescription Drug Plan that may be right for you
Learn more about UnitedHealthcare Medicare prescription drug (Part D) plans
Find a Medicare plan
What kind of documents do I need for a qualifying life event?
When you experience a qualifying life event, you may be asked for documents to confirm the life event.
The type of documentation you need depends on the type of qualifying life event. Talk to your health insurance provider to see what documents are needed for your situation. Here’s a list of common documents you might need for a qualifying life event.
- Marriage certificate
- Divorce decree
- Legal separation papers
- Official birth certificate
- Notice of legal adoption
- Hospital certificate with footprints
- Hospital discharge papers
- Newborn’s hospital wrist band
- Crib tag from the hospital
- Legal certified death certificate for dependent
- Coverage termination notice from the government agency that ended the benefits
- HIPPA certificate of credible coverage
- Signed letter on company letterhead confirmed coverage termination and date coverage ended
- Offer letter from spouse or domestic partner’s new employer showing you are eligible for benefits
- Payroll stub from spouse or domestic partner showing benefits deductions has started
- Proof of prior qualifying health coverage within the last 60 days
- Proof of prior qualifying health coverage within the last 60 days and one of the following:
- Lease or rental agreement
- Mortgage deed if owners use the property as primary residence
- Front and back of driver's license or state identification card
- U.S. Postal Service change of address confirmation
- Official school documentation, including enrollment or housing documentation
- Letter from current or future employer that you relocated for work
- Green card, education certificate or visa if you moved to the U.S. from another country
What if I don’t qualify for a special enrollment period?
If you’re between enrollment periods and haven’t experienced a qualifying life event, there are options, like short term insurance, to bridge the gap. That way, you can help assure that you’re not without insurance at any point.
