What You Should Know about Qualifying Life Events (QLEs)

Open Enrollment on NY State of Health is over, but that doesn’t mean you can’t get health insurance. If you’ve had a Qualified or Qualifying Life Event (QLE), you may be eligible to enroll in a plan. Find out more now.

April 28, 2017 | HF Healthy Living Team

In New York, you can shop for health insurance on NY State of Health, the marketplace designed to help people shop for and enroll in coverage during the Open Enrollment Period. This period typically runs from November through January each year.

If you missed the Open Enrollment Period this year, you may still be able to get health insurance coverage if you’ve had a Qualified or Qualifying Life Event (QLE).

Here’s what you need to know.

What Are QLEs?

A QLE is a major life change or special event that could affect your health coverage or need for health coverage.

There are four types of QLEs:

  • Loss of coverage
  • If you lost your existing coverage—whether it was through your job, through school or college, or through “aging out” of your parents’ coverage—you might be eligible to get a new plan without waiting for the Open Enrollment Period. You might also be able to get a new plan if you lost your eligibility for Medicaid, Child Health Plus, or Medicare.
  • Changes in family or household
  • If you got married or divorced, gave birth, adopted a child, or had a death in the family, you may be eligible to sign up for health insurance outside of the Open Enrollment Period.
  • Changes in residence
  • If you moved to a different zip code or county—whether you were a student moving to or from school; an individual or family moving from a home, shelter, or other transitional housing; or a seasonal worker moving from a place of work—you may be eligible to get health insurance because of your move.
  • Other qualifying events
  • There are many QLEs that might affect your eligibility to get health insurance. They include changes to your coverage qualifications; gaining membership in a federally recognized tribe; becoming a United States citizen; leaving prison; and more.
  • Voluntarily dropping your health coverage or being terminated for not paying your premium are not considered qualifying life events.
  • Click here to learn more and to see a full list of all qualifying life events.

What Is a Special Enrollment Period?

A Special Enrollment Period is when an individual or family can enroll in health insurance outside of the standard Open Enrollment Period because of a qualifying life event. In order to get health insurance during the Special Enrollment Period, typically you must apply within 60 days of a QLE.

If you live in New York and think that you have had a QLE and can enroll during the Special Enrollment Period, visit NY State of Health to learn more now.

Want to know more about health insurance? Learn why it’s important to have. If you need help understanding certain health insurance words—like premium, copay, deductible, etc.—check out our glossary.

 

© 2017 HF Management Services, LLC

Healthfirst is the brand name used for products and services provided by one or more of the Healthfirst group of affiliated companies.

This health information or program is for educational purposes only and not intended to treat, diagnose, or act as a substitute for medical advice from your provider. Consult your healthcare provider and always follow your healthcare provider’s instructions.

Sources
“Qualifying Life Event (QLE),” Healthcare.gov. Accessed March 14, 2017.
https://www.healthcare.gov/glossary/qualifying-life-event/

“Enroll in or change plans with a Special Enrollment Period,” Healthcare.gov. Accessed March 14, 2017.
https://www.healthcare.gov/coverage-outside-open-enrollment/special-enrollment-period/

“Special Enrollment Periods,” NY State of Health. Accessed March 14, 2017.
https://nystateofhealth.ny.gov/specialenrollment.html

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