Saturday, August 13, 2022

What Qualifies As A Life Changing Event For Insurance

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Which Health Insurances Permit Qualifying Life Events


Not all health insurance providers recognize qualifying life events. For example, ACA-compliant medical plans recognize qualifying life events such as marketplace, group coverage, or semi-compliant grandfathered plans.

However, if you experience a qualifying life event, short-term medical plans wont allow you to make changes to your coverage.

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What Documents Can I Use To Prove A Qualifying Life Event

Who is this for?

If you need to buy health insurance or make changes to your coverage during special enrollment, this explains what you’ll need.

Everyone can enroll in an individual health insurance plan during open enrollment. But sometimes events like a birth or marriage mean you’ll need to change your coverage at another time of the year. These are called qualifying life events. After a qualifying life event, you have a period of 60 days to change your plan or enroll in a new plan. You also may be able to select a plan up to 60 days in advance of some qualifying life events. This can be during open enrollment or after open enrollment has ended.

You can use any of the following qualifying life events to enroll in one of our plans during a special enrollment period. For any of these events, please be sure to provide us with one of the documents listed below. Some events may require more than one document.

New To The Public Service

  • What is the Public Service Health Care Plan?

    The Public Service Health Care Plan is an optional health care plan for federal public service employees and their dependants. It is designed to supplement provincial health insurance plans. The PSHCP provides:

  • Supplementary Coverage which is intended for members who are covered under a provincial/territorial health insurance plan. It provides participants with health coverage to supplement the coverage provided under the provincial/territorial plan in the members province/territory of residence.
  • The Plan covers expenses for a range of health care services and supplies such as, prescription drugs, vision care and the services of various medical practitioners under its Extended Health Provision.
  • The Plan also includes three levels of hospital benefits under the Hospital Provision that provide reimbursement up to a specific dollar amount in excess of standard ward charges.
  • Comprehensive Coverage which is intended for members and their eligible dependants who are residing outside of Canada and who are not covered under a provincial/territorial health or hospital insurance plan.
  • For more information on the PSHCP, refer to the PSHCP Directive.

  • Note: As a retired member under the PSHCP you will have different contribution rates. See Preparing for retirement.
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    Gaining Access To A Qsehra Or Individual Coverage Hra

    This is a new special enrollment period that became available in 2020, under the terms of the Trump administrations new rules for health reimbursement arrangements that reimburse employees for individual market coverage. QSEHRAs became available in 2017 and allow small employers to reimburse employees for the cost of individual market coverage . But prior to 2020, there was no special enrollment period for people who gained access to a QSEHRA.

    As of 2020, the Trump administrations new guidelines allow employers of any size to reimburse employees for the cost of individual market coverage. And the new rules also add a special enrollment period listed at 45 CFR 155.420 for people who become eligible for a QSEHRA benefit or an Individual Coverage HRA benefit.

    This includes people who are newly eligible for the benefit, as well as people who were offered the option in prior years but either didnt take it or took it temporarily. In other words, anyone who is transitioning to QSEHRA or Individual Coverage HRA benefits regardless of their prior coverage has access to a special enrollment period during which they can select an individual market plan , on-exchange or outside the exchange.

    This special enrollment period is available starting 60 days before the QSEHRA or Individual Coverage HRA benefit takes effect, in order to allow people time to enroll in an individual market plan that will be effective on the day that the QSEHRA or Individual Coverage HRA takes effect.

    What To Do If You Experience A Qualifying Event

    Benefits A

    If you experience a qualifying event, you will need request a change to your benefits within 30 calendar days of the event and provide required documentation. If you do not request the change within 30 calendar days, the next opportunity you will have to make changes to your benefits will be during the next open enrollment period.

    You must contact State Personnel Benefits to remove dependents who no longer meet eligibility previously mentioned . Even outside of 30 calendar days, these life changing events must still be reported to remove ineligible dependents from your coverage. Failure to remove ineligible dependents within the time limit can lead to penalties including disciplinary action or prosecution.

    A temporary extension of the time frame to report qualifying events was put in place effective March 1, 2020. However, those time frames are scheduled to be reinstated starting March 1, 2021.

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    Public Service Dental Care Plan

    Once you are eligible for the Public Service Dental Care Plan , you will need your Plan Number and Certificate/ ID Number to register for Canada Life GroupNet.

    Plan Numbers by group:

    • Plan 55555 National Joint Council Component
    • Plan 55666 Public Service Alliance of Canada
    • Plan 55777 Canadian Armed Forces Dependants
    • Plan 55888 Royal Canadian Mounted Police Dependants
    • Plan 55999 Canadian Armed Forces Reserves

    Locate your Certificate/ ID Number:

    • On your PSDCP benefit card
    • Through the Phoenix Pay System application, if you have access to the Compensation Web Applications
    • By contacting the Public Service Pay Centre or your departmental compensation unit
    • On an Explanation of Benefits statement sent to you by Canada Life

    To access the Canada Life GroupNet mobile app for PSDCP members, download the Canada Life mobile app for iPhone and Android devices from the App Store or Google Play.

    • You must first register an account before you are able to sign in. To register, you must enter your member ID and plan number provided to you on your PSDCP benefit card.
    • Sign into the app using your email address and password.
    • Select Make claim, then select Start online claim.
    • Select your claim type and follow the steps to submit your claim.

    Should you have any questions regarding the GroupNet website or how to register, please call Canada Life at 1-855-415-4414.

    Loss Of Health Coverage

    Losing coverage and losing eligibility may include if you no longer have access to health coverage through a job or an insurance policy you bought on your own, you become ineligible for Medicare, Medicaid, or the Childrens Health Insurance Program or you lose coverage through a family member. For example, children turning 26 and can no longer be covered by your parents health plan or if your spouse loses a job and you no longer have health coverage.

    There are also other situations in which you may qualify for a special enrollment period see Healthcare.govs Special enrollment periods for complex issues page for more information.

    The qualifying life events may be slightly different for employer coverage.

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    Death In The Family: Lisa Starts A New Chapter

    Lisa, 53, recently lost her husband, James, to a heart attack. Her friends have been great about checking in on her and lifting her spirits. Theyve also helped her update financial accounts and other practical matters. Before James’ death, for instance, Lisa was covered under his employers health insurance plan. Now, Lisa no longer qualifies for that plan.

    In cases like Lisa’s, surviving spouses are entitled to COBRA coverage, but Lisa chooses another option. Since the death of a spouse is a qualifying life event, she can enroll in her employers health plan. Under her new coverage, she finds a counselor who helps her cope with her grief and look to the future with hope and gratitude.

    Other changes in household include:

    • Getting married or divorced
    • Having a baby or adopting a child.

    Becoming A Dependent Or Gaining A Dependent

    MOVING ABROAD ALONE IN YOUR 30s *life changing*

    Becoming or gaining a dependent is a qualifying event. Coverage is back-dated to the date of birth, adoption, or placement in foster care . Because of the special rules regarding effective dates, its wise to use a special enrollment period in this case, even if the child is born or adopted during the general open enrollment period.

    The current regulation states that anyone who gains a dependent or becomes a dependent is eligible for a special open enrollment window, which obviously includes both the parents and the new baby or newly adopted or fostered child. But accepts applications for the entire family during the special open enrollment window.

    The market stabilization rule that HHS finalized in April 2017 added some new restrictions to this SEP: If a new parent is already enrolled in a QHP, he or she can add the baby/adopted child to the plan . Alternatively, the child can be enrolled on its own into any available plan. But the SEP cannot be used as an opportunity for the parent to switch plans and enroll in a new plan with the child.

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    Term Insurance Policy Coming Up For Renewal

    If you own term life insurance, rates are only guaranteed to stay level for a specific term after which the rates change, usually increasing drastically. One thing insurance companies wont tell you is that they build a buffer into the pricing when renewing a term life insurance policy. They assume the insured is in poor health at the time of renewal and add this higher cost of insurance into the the renewal premium. If the insured is in good health, he or she should likely reapply for a new plan.

    It important to never cancel an existing policy until the new plan is approved and in force first. If the new policy application is declined or rated it may be a better idea to pay the renewal rates with the existing policy. Thus, its advisable to reapply for new term life insurance at least 6 months prior to the existing policy renewal date.

    Qualifying Life Events And Special Enrollment Periods

    When you experience a qualifying life event, it triggers a Special Enrollment Period that lasts 60 days after your event. The Special Enrollment Period is what grants policyholders access to their ACA-compliant health insurance.

    Be sure to make changes within the 60-day window otherwise, youll lose the opportunity to access ACA-compliant health plans. Although, you can still apply for Medicare or purchase health coverage through insurance.

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    Do You Need A Qualifying Event To Cancel Health Insurance

    Not necessarily. If you have private health coverage thats not employer-sponsored, you can cancel your health insurance policy at any point during the year. If you have group insurance, you need a qualifying event to terminate your policy. One exception is if youre leaving the job and no longer qualify for employer-sponsored health insurance.

    Special Enrollment Period Examples:

    Insurance Benefits Qualifying Events / Benefits Solutions Group What Is ...
    • Having been kept from enrolling during Open Enrollment due to a serious medical condition or a natural disaster

    • If someone working in an official capacity prevented enrollment, made a mistake in enrollment, gave wrong information, etc.

    • If a technical error occurred or if wrong policy data was displayed on the Exchange

    • Applying for Medicaid or CHIP during open enrollment but being deemed ineligible after open enrollment ended

    • Gaining a new dependent or becoming dependent on someone else due to a court order

    • Surviving domestic abuse or spousal abandonment and enrolling in a new, personal health policy

    • Filing and winning an appeal after an incorrect eligibility determination

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    Remarrying Or Reaching Common

    • Is your new spouse, common-law partner and/or dependant child eligible to be covered under your group insurance benefit plans?

      If you have opted for coverage under the Public Service Health Care Plan or the Pensioners Dental Services Plan as a survivor, you can apply for coverage for your new eligible spouse, common-law partner and/or dependant children.

      In general, an eligible spouse or common-law partner means:

    • the person to whom you are legally married or your common-law partner .

    In general, an eligible child includes an unmarried child of a member, of the members spouse or of the members survivor , including a stepchild, an adopted child and a foster child for whom the member stands in place of a parent.

    To be dependant, the child must be:

    • under 21 years of age
    • under 25 years of age and attending an accredited school, college or university on a full-time basis or
    • incapable of engaging in self-sustaining employment by reason of mental or physical impairment and is primarily dependant upon the member, provided such impairment occurred by the ages indicated above.
  • How can you apply for group insurance benefits for your new spouse, common-law partner and/or dependant child?

    To apply for:

  • The Public Service Health Care Plan :
  • Changes can be made to your positive enrolment information by visiting the Sun Life Member Services website. Alternatively, you can request a paper positive enrolment form by contacting Sun Life.
  • The Pensioners Dental Services Plan :
  • If You Experience A Qualifying Life Event Sign Up Right Away

    In most situations, youll need to make changes to your health plan within a specific time frame of the qualifying life event.

    • Changes can most often be made either 30 or 60 days after the qualifying life event happen
    • Missing this deadline could mean having to wait until the next open enrollment, which could be as long as a year

    If youve experienced a qualifying life event, check your plan materials, contact your employer or call the phone number on your member ID card.

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    Definition And Examples Of Qualifying Life Events

    You can sign up for and make changes to your health plan every year during open enrollment. You can also shop for a health plan outside of that window of timebut only if you have a qualifying life event.

    These events can include getting married, divorced, or having a child. You have a special time during which you can make changes to your health plan after one of these events.

    • Acronym: QLE

    What Do I Do Now

    This Simple Van Mod Makes Life SO Much Easier!

    Know that you have choices. Plan cancellations are a reality. The good news is that most plans are changing for the better.

    Due to the Affordable Care Act , coverage has expanded to include essential health benefits like preventive care, mental health services, maternity benefits and much more. Now that your old plan is no longer an option, were here to help you find something that suits your current needs.

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    A Change In Residence

    Moving within your town or city may not qualify you for a special enrollment period. Still, there are specific residence changes that allow you to change your insurance as a qualifying life event. Here are a few:

    • Moving to a different state, county, or zip code
    • A student moving to or from your school
    • A seasonal worker who must move for work
    • Moving to or from transitional housing, like a shelter

    If you have changed addresses, you have 60 days to provide legal documentation of your residence change, including a rental agreement, mortgage deed, and valid identification card.

    What Are Qualifying Life Events

    You may qualify for a special enrollment period if something major changed in your life. Those major changes are called qualifying life events or qualified status changes. Examples of qualifying life events include:

    • Birth
    • Permanent move
    • Involuntary loss of current health insurance

    In most situations, you have 60 days from the date of the event to apply for new coverage.

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    Planning For What’s Next

    When big changes happen, updating life insurance coverage might not immediately come to mind, but it can help to think of it as you would think about keeping your health insurance policy current. Taking prompt action to handle what qualifies as a life-changing event for insurance can help you maintain your plans for your family’s future and the preservation of your legacy.

    Other Qualifying Life Events

    Insurance Life Changing Event

    You may become eligible for another QLE that allows you access to health coverage without having to wait for the next open enrollment period. Here is a list:

    • Becoming a U.S. citizen or legal resident
    • Becoming a member of a federally recognized tribe or obtaining shareholder status through the Alaska Native Claims Settlement Act
    • A significant change in income that changes your qualifications
    • Leaving incarceration
    • Starting or ending an AmeriCorps service

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    How Long After A Life Event Can You Change Insurance

    When you make big decisions in life, you may be eligible to buy or change Health Insurance MarketplaceĀ® coverage outside the yearly Open Enrollment Period. If youve had a qualifying major life event, you have 60 days from the life event to enroll in coverage. You can apply or change plans online or by phone.

    What Happens If I Don’t Take Any Action

    If you remain eligible for your current health plan and wish to continue coverage following a QLE, you dont need to take action.

    If you aren’t already in a health plan and don’t enroll in one, you’ll only be eligible for care at a military hospital or clinic if space is available.

    When retiring from active duty, you must make an enrollment decision within 90 days of your retirement. If you dont enroll in a health plan within the 90-day period, youll lose TRICARE coverage and may only be eligible for care at military hospitals or clinics if space is available.

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