Qualifying Life Events explained

Typically, you must enroll in health coverage during the annual Open Enrollment Period (OEP) from November 1 to January 31. But did you know that certain life-changing events qualify you for a Special Enrollment Period (SEP) and allow you to enroll in coverage outside of the OEP dates?

What is a Qualifying Life Event (QLE)?

A Qualifying Life Event is a change in your circumstance that may allow you to enroll in coverage outside the annual open enrollment period.

A Qualifying Life Event (see the list below) can occur anytime during the year. If you experience a qualifying event, you usually have up to 60 days after the event to enroll or change your health plan. Certain life events allow you to apply for a health plan up to 60 days before the event, like moving into an insurer’s coverage area. If you are losing coverage provided by an employer, you will have up to 60 days before and after the event to enroll in a health plan.

What qualifies as a qualifying event?

Family changes

You may be eligible for a SEP if you (or anyone in your household):

  • Got married or divorced, or had a death in the family
  • Had a child, adopted a child, or gained a child through foster placement
  • Gained or lost a dependent, including due to child support or other court order

Turning 26

If you’re a dependent on your parent’s health plan, and you’re turning 26, the following SEP timeframes apply:

  • If you’re aging off of your parent’s State Based Exchange plan: You can stay on your parent’s plan until coverage ends December 31, even if you turn 26 mid-year. But be sure to apply for your own State Based Exchange plan for next year by the Open Enrollment deadline, December 15. Your parent will also need to update their application showing you won’t be on their plan next year.
  • If you’re aging off of your parent’s employer plan: Your coverage usually ends the month you turn 26. Even if it’s outside OEP, you’ll be able to get a State Based Exchange plan because losing other coverage qualifies you for a SEP. You’ll have 60 days before you lose coverage and 60 days after that to enroll. The State Based Exchange may ask you to provide documents to confirm you lost coverage.

Change of address

You may be eligible for a SEP if you (or anyone in your household):

  • Moved to a new home in a new ZIP code or county
  • Moved to the U.S. from a foreign country or U.S. territory
  • Moved to or from the place you attend school
  • Moved to or from the place of your seasonal employment
  • Moved to or from a shelter or other transitional housing

Employment Status Change

You may be eligible for an SEP if you lost coverage because of the following events:*

  • Lost coverage through your job
  • COBRA coverage expired
  • Lost your individual or group health plan coverage during the year

*Loss of coverage due to voluntarily canceling your health insurance plan, having your plan canceled because you did not pay your premium or because your plan did not meet the requirements as stated by the Health Care Law do not qualify as life events that allow you to enroll during a SEP.

Complex issues

There are many complex situations that may qualify you for an SEP. For the full list of complex issues that may qualify you for a SEP, visit GetCovered.NJ.gov.

Turning 65

Turning 65 is a unique Qualifying Life Event — and usually, your first chance to sign up for Medicare is when you turn 65. This is called your Initial Enrollment Period. It lasts for seven months, starting three months before you turn 65 and ending three months after

the month you turn 65.

Learn more about Medicare and find out when you can sign up. Visit Get started with Medicare.

What kind of health plan can I apply for with a Qualifying Life Event?

With a QLE, you can sign up for the health plans available on either GetCovered.NJ.gov, or amerihealthnj.com. While there may be cost-saving options available to you when applying directly through AmeriHealth New Jersey, you are not eligible for tax credits. Tax credits are only available through the GetCovered.NJ.gov.

To shop for plans and enroll, visit or call:

  Online Phone
New Jersey State Based Exchange GetCovered.NJ.gov 833-677-4265
AmeriHealth New Jersey AmeriHealthNJ.com 888-968-7241