Special Enrollment and Qualifying Life Events

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:

  • Change in household size
    • Birth
    • Marriage
    • Adoption/Foster care
    • Court order
    • Death of policy holder
    • Legally separated or divorced from your spouse
  • 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
    • Losing coverage under a parent’s health plan/dependent turning 26
  • Permanent move into insurer’s network
    • You change your permanent residence to the AmeriHealth New Jersey service area
    • You become a U.S. citizen
  • Enrollment or plan error
  • Denial of Medicaid or CHIP application
  • Victim of domestic abuse

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 and after this 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.

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.

* Please be advised that the following events that lead to loss of health care coverage do not qualify as life events that allow you to enroll during a Special Enrollment Period:

  • Voluntarily canceling your health insurance plan
  • Having your plan canceled because you did not pay your premium
  • Having your health care coverage rescinded because of fraud or international misrepresentation of material fact
  • Your health plan did not meet the requirements of the Affordable Care Act

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.