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Qualifying life events

Typically, you must enroll in health coverage during the annual Open Enrollment Period (OEP) from November 1 to January 31. But, certain life-changing events qualify you for a Special Enrollment Period (SEP) and allow you to enroll in coverage outside of the OEP dates.

What is a qualifying life event?

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.

A Qualifying Life Event (see the list below) can occur anytime during the year. If you experience a qualifying event, you usually have up to 60 days after the event to enroll or change your health plan. Certain life events allow you to apply for a health plan up to 60 days before the event, like moving into an insurer's coverage area. If you are losing coverage provided by an employer, you will have up to 60 days before and after the event to enroll in a health plan.

What qualifies as a qualifying life event?

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 Losing coverage through your job⁴ Legally separated or divorced from your spouse COBRA expiration Losing eligibility for Medicaid or CHIP Denial of open CHIP or Medicaid application after Open Enrollment Victim of domestic abuse or spousal abandonment	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. If you apply between March 3 and April 30, your coverage will be effective on May 1 If you apply between May 1 and May 31, your coverage will be effective on June 1 If you apply between June 1 and June 29, your coverage will be effective on July 1
Moved into the insurer’s coverage area You change your permanent residence to the AmeriHealth service area You become a U.S. citizen Moved to a new home in a new ZIP code or county where your plan is not offered Moved to or from the place of your seasonal employment to a place where your plan is not offered Moved to or from a shelter or other transitional housing to a place where your plan is not offered	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. If you apply between April 2 and April 15, your coverage will be effective on May 1 If you apply between April 16 and May 15, your coverage will be effective on June 1 If you apply between May 16 and June 15, your coverage will be effective on July 1 If you apply between June 16 and June 29, your coverage will be effective August 1

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 26

If you’re a dependent on your parent’s health plan, and you’re turning 26, the following SEP timeframes apply:

If you’re aging off your parent’s Marketplace plan: You can stay on your parent’s plan until coverage ends December 31, even if you turn 26 mid-year. But be sure to apply for your own health plan by December 15 for coverage to start January 1. Your parent will also need to update their application showing you won’t be on their plan next year.
If you’re aging off your parent’s employer plan: Your coverage usually ends the month you turn 26. Even if it’s outside OEP, you’ll be able to get your own health plan because losing coverage qualifies you for a SEP. You’ll have 60 days before you lose coverage and 60 days after that to enroll. You may be asked to provide documents to confirm you lost coverage.

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. Learn more.

What kind of health plan can I apply for with a Qualifying Life Event?

With a QLE, you can sign up for the health plans available at Get Covered New Jersey, New Jersey’s Official Health Insurance Marketplace or amerihealth.com. While there may be cost-saving options available to you when applying directly through AmeriHealth, you are not eligible for tax credits. Tax credits are only available through State-based exchanges.

1 Loss of coverage due to voluntarily canceling your health insurance plan, having your plan canceled because you did not pay your premium or because your plan did not meet the requirements as stated by the Health Care Law do not qualify as life events that allow you to enroll during a Special Enrollment Period.

2 This is the date the adopting parents receive the adoptee, regardless of whether papers were filed.

3 If the loss of coverage is due to a Qualified Health Plan decertification, the life event is the official notice of decertification. In all other cases, it is the date the individual loses eligibility for Affordable Care Act compliant plan.

4 If you recently lost your job, health care coverage through COBRA (Consolidated Omnibus Budget Reconciliation Act) may be an option for you. COBRA allows you to temporarily maintain the same health benefits you had with your employer’s plan. It’s available to most employees whose employer coverage has been terminated. If your employer has 20 or more employees, visit www.dol.gov and search for “COBRA”. If your employer has fewer than 20 employees, visit www.pa.gov and search for “Mini-COBRA”.