A qualifying life event is any change to an individual’s circumstances that allows them to make adjustments to their benefits despite the time of the year. These include losses in health coverage, changes in the household, changes in residence, and others.

Typically, employees are only eligible to make adjustments during the company’s open enrollment period, which often (but not always) takes place towards the end of the year.

According to the Federal government, there are four primary types of qualifying events:

Loss of health coverage: This can include job-based and individual coverage, as well as student health plans. For example, these events occur when a person is:

• • laid off
  • fired
  • company/organization shuts down operations
  • the person leaves college

Additionally, other instances include losing eligibility for Medicare, Medicaid, or CHIP, and when a person loses coverage through a parent’s plan after turning 26. 

Changes in household: Changes include marriage, divorce, the birth of a baby, adopting a child, and death in the family

Changes in residence: Examples include:

• • moving to a different ZIP code or county
  • a student moving to or from the place where they attend school
  • a seasonal worker moving to or from the place they both live and work
  • moving to or from a shelter or other transitional housing.

Other qualifying events: Other types of events can include:

• • changes in a person’s income that impact the coverage they qualify for
  • gaining membership in a federally recognized tribe or status as an Alaska Native Claims Settlement Act (ANCSA)
  • becoming a U.S. citizen
  • leaving incarceration
  • AmeriCorps members beginning or ending their service

Related Terms: Floating Holidays