What is Considered a Qualifying Event for Group Health Insurance

Every year millions of people sign up for health insurance plans during their employer’s open enrollment period. For workplace health insurance plans, the employer sets the enrollment window. This period is typically one month prior to the current plan’s renewal. Many companies hold open enrollment in the fall with coverage being effective for the upcoming calendar year. Most people don’t realize, however, that you can join a group health insurance policy, as well as add or subtract people on an existing policy, outside of the open enrollment period – provided you are experiencing a “qualifying event.”

Qualifying Life Events

There are several types of events that may make you eligible to change your current policy, or to enroll in a health insurance plan, without waiting for the next open enrollment period. Most of these “Special Enrollment” events are related to changes in job, family, or income status:

  • Marriage
  • Separation
  • Divorce
  • Birth of a Child
  • Adoption
  • Change in Dependents
  • New Hire
  • Court Orders
  • Change in Residence
  • Change in Spouse’s Benefits
  • Change in Spouse’s Employment Status
  • Change in Work Hours
  • Loss of Coverage
  • Loss of a Dependent
  • Change in Dependent Eligibility
  • Change in Living Location

Simply stating that these events occurred is not sufficient. You will need to supply proof of the qualifying event at the time of the change or enrollment application.

Qualifying Event Deadlines

Just as there is an open enrollment deadline, there is also a time limitation on special enrollment. If you have a qualifying event, you generally have 30 or 60 days from the date of the event to make changes to your health insurance policy. The time limit depends upon your plan’s requirements.

If you do not make the changes before the period expires, you will need to wait until the next open enrollment to do so. It is important to notify your insurer of your qualifying event as soon as possible. Different plans have different rules, so getting a jump on the changes is important.

If you are seeking a new plan that works best for your employees, Dawson Benefits is the skilled insurance concierge for you. We don’t leave you scrambling to figure out any of your insurance questions alone. Instead, we take care of individuals, businesses, and employees, assisting with everything from policy selection to claims issues.Call 201 258 4669 to set up a free consultation today!