HR Glossary
Qualifying life event

Qualifying life event

Updated on:
August 22, 2022


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What is the qualifying life event? 

A qualifying life event is a significant change in a person's life, such as a marriage, birth of a child, divorce, or a purchase of a home, which can have an impact on insurance coverage.

Qualifying life events can increase or decrease coverage, or result in an adjustment to premiums.

Qualifying events may include the birth of a child, divorce, marriage, loss of job, death of the insurance holder, and change in the insured's employment status.

Ideally, qualifying events should be reported quickly so that the carrier can make an informed decision.

For an insurance contract to be valid, certain conditions must be met. These conditions are referred to as qualifying events.

Qualifying events include, but are not limited to, material misrepresentations made in applying for insurance, illegal acts, malicious acts, and fraudulent acts committed by the applicant.

Qualifying events also include material misrepresentations made by the insured. A material misrepresentation is an inaccurate information presented to an insurer or information about which the insurer has reason to believe would be inaccurate.

Loss of Health Insurance:

  1. Turning 26 years old and losing coverage through a parent’s insurance plan
  2. Losing job-based coverage, COBRA, or a student plan
  3. Losing eligibility for Medicare, Medicaid, or the Children’s Health Insurance Program (CHIP)
  4. Losing health insurance for any reason other than not paying the premiums

There are several reasons why qualifying events for insurance are necessary:

First, they ensure that people who purchase insurance are actually covered for the things they need. 

Second, qualifying events help to ensure that people do not wait until they need insurance to purchase it, which would allow them to game the system. 

Finally, qualifying events help to keep insurance premiums affordable by making sure that people who need insurance the most are the ones who are covered.

How long do you have to sign up for a new health insurance plan after a qualifying event?

A special enrollment period generally lasts 60 days after a qualifying event. This allows an individual to make changes to their plan or sign up for a new health insurance plan immediately.