Qualifying life events
A qualifying life event, also known as a QLE, is a change in circumstance that may allow you to enroll in coverage outside of the annual Open Enrollment period.
Qualifying life events include:
- Birth
- Marriage
- Adoption/foster care
- Loss of coverage1
- Permanent move into insurer’s network
- Becoming a U.S. citizen
For the following qualifying life events, please visit GetCovered.NJ.gov:
- You have a change in income or household status that affects your eligibility for premium tax credits or cost-sharing reductions.
- If you are a member of a federally recognized American Indian tribe or Alaskan Native, you have an open enrollment throughout the year and can change plans as often as once a month.
Timing of qualifying life events and the Special Enrollment Period
The following chart provides more details about qualifying life events and the timing of Special Enrollment periods resulting from them.
Qualifying life event | Effective date of coverage | Special enrollment period | Example |
---|---|---|---|
Birth (Not limited to child only) |
Date of birth | Up to 60 days after the event | Your child is born on May 1. You have until June 29 to apply for an effective date of May 1. |
Adoption/Foster care2 (Not limited to child only) |
Date of adoption or placement | Up to 60 days after the event | Your child is placed with family on May 1. You have until June 29 to apply for an effective date of May 1. |
Loss of coverage3
|
If the loss of coverage is in the future: the first (1st) of the month following the loss of coverage If the loss of coverage is in the past: the first (1st) of the month following the date the application was submitted |
Up to 60 days before and up to 60 days after the event | You will be losing health care coverage through your job on May 1 (future date). You may apply for coverage anytime between March 3 and June 29.
|
Moved into the insurer’s coverage area
|
If within the first 15 days of the month: the first (1st) of the following month after the application has been submitted On or after the 16th of the month: the first (1st) of the second month following the submission of the application |
Up to 60 days after the event | You are moving into the AmeriHealth coverage area effective May 1. You may apply for coverage anytime between April 2 and June 29.
|
Complex issues
There are many complex situations that may qualify you for an SEP. For the full list of complex issues that may qualify you for a SEP, visit GetCovered.NJ.gov.
Turning 65
Turning 65 is a unique Qualifying Life Event — and usually, your first chance to sign up for Medicare is when you turn 65. This is called your Initial Enrollment Period. It lasts for seven months, starting three months before you turn 65 and ending three months after the month you turn 65.