Special Enrollment and Qualifying Life Events

You may still be eligible to enroll in or make changes to a health plan during Special Enrollment if you have a Qualifying Life Event.

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Qualifying Life Events

A Qualifying Life Event is a change in circumstance that may allow you to enroll in coverage outside of the annual Open Enrollment Period.

Qualifying Life Events include:

  • Birth
  • Marriage
  • Adoption/Foster care
  • Loss of coverage because of the following events*
    • Losing coverage through your job
    • COBRA expiration
    • Losing eligibility for Medicare, Medicaid, or CHIP
    • Losing individual or group health plan coverage during the year
    • Legally separated or divorced from your spouse
    • Death of policy holder
    • Losing coverage under a parent’s health plan/dependent turning 26
    • Determined ineligible for Medicaid or CHIP after Open Enrollment
    • Experience domestic abuse/violence or spousal abandonment
  • Permanent move into insurer’s network
    • You change your permanent residence to the AmeriHealth New Jersey service area
  • You become a U.S. citizen

When Can I Enroll During a Special Enrollment Period?

The Special Enrollment Period is determined by the type of qualifying life event. In most cases, you will have 60 days after the qualifying life event to enroll in or make changes to a health plan.

Certain life events, like moving into the AmeriHealth New Jersey coverage area, allows you to apply for a health plan up to 60 days before a qualifying life event. If you are losing health care coverage provided by an employer, you will have up to 60 days before and after this qualifying life event to enroll in a health plan.

When you apply for a Special Enrollment Period for the following qualifying life events, you will be sent an Eligibility Notice for Coverage.

  • Loss of minimum essential coverage
  • Change in primary place of living (“permanent move”)
  • Birth
  • Gaining a dependent through adoption, placement for adoption, placement in foster care, or a child support or other court order
  • Marriage

This notice will include a list of acceptable documents you may provide to prove your eligibility for the Special Enrollment Period. Please provide these documents by the deadline listed in the notice to avoid disruptions to your health care coverage. You must send the documents before you can start using your health care coverage. You can preview the Eligibility Notice (under “Special Enrollment Periods”). Learn more about acceptable documents and when the Health Insurance Marketplace requires you to submit documentation.

For the following Qualifying Life Events, please visit healthcare.gov:

  • You have a change in income or household status that affects your eligibility for premium tax credits or cost-sharing reductions.
  • If you are a member of a federally recognized American Indian tribe or Alaskan Native, you have an open enrollment throughout the year and can change plans as often as once a month.

* 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 Special Enrollment Period.

How To Apply During a Special Enrollment Period

  • If you have questions regarding choosing a health plan or enrolling in a health plan, call AmeriHealth New Jersey at 877-744-5422
  • If you are eligible for financial assistance, please visit the Health Insurance Marketplace.