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What Is an IRS Qualifying Event for Health Insurance? – ValuePenguin

Health insurance qualifying events are events that alter the amount of health insurance you need or change the health policies you can buy. a qualifying life event is a requirement to access special enrollment periods.

During these periods, you can choose a new health policy or upgrade your existing insurance coverage. To take advantage of a special enrollment period, you generally need proof of the qualifying life event so changes to your health insurance can be approved. however, if you lose open enrollment and do not have a qualifying life event, there are still options available to purchase health insurance.

Reading: What counts as a qualifying event for health insurance

what is considered a qualifying life event (qle)?

Qualifying life events are those situations that cause a change in your life that has an effect on your health insurance options or requirements. The IRS states that a qualifying event must impact your insurance needs or change the health insurance plans for which you qualify. in either case, the qualifying life event would trigger a special enrollment period that would make you eligible to select a new individual insurance policy through the state marketplace.

qualifying events are evaluated on a case-by-case basis by an insurer. You can see a full list of qualifying life events at healthcare.gov.

what is a special enrollment period (September)?

Under the Affordable Care Act (ACA), a special enrollment period is a set period in which you would be allowed to enroll in or change your health insurance coverage. the special enrollment period lasts 60 days from the date of a qualifying life event. During these 60 days, you will be allowed to enroll in a new health plan.

Once the 60 days have expired, the sep will be over. at that point, you would have had to apply for a new policy to receive coverage. If you didn’t choose a policy and don’t have existing coverage, then you wouldn’t have health insurance, or you could enroll in state programs like Medicaid if you’re eligible.

qualifying events for employer-sponsored programs

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qualifying life events can change your coverage requirements and therefore affect group health insurance and flexible spending accounts (fsa) offered through your job. fsas are arrangements with your employer that allow you to pay for out-of-pocket medical, dental, or vision care expenses with tax-free dollars. You can decide how much money you put into an FSA up to a limit set by your employer.

If you encounter a qualifying life event, you will be given the opportunity to change any of the selections you previously made in your fsa plan. For example, if you had a child and wanted to increase your contribution to your flexible spending account, you would be allowed to do so because adding a dependent is a qualifying life event.

Group health insurance is affected by qualifying life events, as the event may alter the amount of insurance you need or the number of people covered by the policy. The Health Insurance Portability and Accountability Act (HIPAA) allows employees who have experienced a qualifying life event to enter a special enrollment period where they can select a new group health plan. This can be very helpful if you’re recently married, for example, as you may want to add your spouse to your health insurance policy.

should i use cobra insurance?

If you were fired from your job or decided to quit, it would trigger a qualifying life event. In this case, a special enrollment period would be activated in which you would have two options: take out a new health insurance policy or extend your current coverage under charges.

The Consolidated Omnibus Budget Reconciliation Act (COBRA) is an insurance law that temporarily extends job-based insurance coverage offered by employers. This law allows employees to keep their group health insurance plans when they would normally lose coverage after being laid off. however, selecting cobra can be expensive because your employer will no longer contribute to the premium payments.

You can voluntarily cancel your collect coverage or stop paying premiums on a collect policy, but it’s important to know that this would not be considered a qualifying life event. therefore, you would not be eligible for a special enrollment period if you wanted to purchase individual health insurance. For this reason, if you have recently been laid off or resigned, we recommend that you evaluate the costs of the health plans here and charge before choosing one as your policy.

how to test a qualifying event

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After applying for Marketplace coverage during a special enrollment period, you may be required to provide documentation of your qualifying life event so the insurance provider can confirm that you meet the separation requirements.

once you have selected a health insurance plan, you will have 30 days to submit documents to the insurance provider detailing your qualifying life event. It is important to note that your policy will start when you have chosen a plan, but you will not be able to use the insurance until your eligibility has been confirmed and the initial premium has been paid. additionally, if you are not approved for a separation, the policy will be canceled or you will need to provide additional documents to support the qualifying event.

Can I cancel my health insurance without a qualifying event?

You can cancel your individual health insurance plan without a qualifying life event at any time. but it’s important to remember that once you cancel your policy, you won’t be able to re-enroll until the next open enrollment period. during this time you will not have health insurance coverage, which could be expensive if you are injured.

On the other hand, you can’t cancel an employer-sponsored health policy at any time. If you wanted to cancel an employer plan outside of the company’s open enrollment, you would require a qualifying life event. under section 125 of the internal revenue code, if you decide to cancel without a qle, then you and your employer will incur tax penalties.

what if I missed open enrollment and don’t have a qle?

If you missed open enrollment and don’t have a qualifying life event, then you may be eligible for a public program like:

Both of these options have year-round enrollment and can be helpful for families who can’t afford individual health insurance. Another option if you’re not eligible for Medicaid might be short-term or temporary health insurance. These types of plans are offered directly from an insurer and can be purchased at any time without a qualifying life event. But these policies can be expensive and may lack benefits like prescription drug services.

See also: Understanding Your Insurance Policy | Department of Insurance, SC – Official Website

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