What Constitutes a Qualifying Life Event?

bigstockphoto___155599Negotiating new terminology is one of the toughest parts to understanding all the recent changes in health care policies and procedures.  Terms like “open enrollment,” government subsidies,” and “qualifying life event (QLE)” can be confusing even to the most thorough students of health insurance and the Affordable Care Act.  When applying for health coverage, however, understanding these terms and how they can affect your health care options is an absolute imperative.

Under the Affordable Care Act, there are two different periods in which an individual may apply for health insurance.  The first is referred to as Open Enrollment and during this time any person may apply for health coverage.  During Special Enrollment, however, there are more restrictions and a person is required to have what is referred to as a Qualifying Life Event (QLE) in order to acquire health insurance.  If you do not have one of these Qualifying Life Events, you may not purchase health insurance during Special Enrollment and must wait until the Open Enrollment Period.  This is not a Blue Cross Blue Shield of North Carolina policy, but rather a policy of the federal government under the Affordable Care Act with which BCBSNC must comply.

Basically, a Qualifying Life Event is a specific circumstance that has altered your life—and there are strict guidelines to determine exactly what qualifies.  For example, a recent  marriage, divorce or birth of a child are all events that would make you eligible to enroll in health coverage during a Special Enrollment period, so long as you enroll within 60 days of that life altering event.  Losing previously held health insurance involuntarily is another example of a Qualifying Life Event, as is changing your permanent place of residence. If your income increases so that you are no longer eligible for Medicaid, you are also able to enroll in new coverage during a Special Enrollment Period.  Because the list of Qualifying Life Events is so varied, however, it is worth investigating whether you qualify to enroll during a Special Enrollment period.

Although the terminology can be confusing, it is important for you to understand what constitutes a Qualifying Life Event because it can have a huge impact on your ability to purchase health insurance.  In addition, the effective date of your coverage will depend on your QLE and the date of your application.

For more information on health insurance coverage in North Carolina, please visit our website at or call our toll free number 888-765-5400 and speak with one of our professional agents. Our agency provides coverage for health insurance in North Carolina through Blue Cross Blue Shield of North Carolina (BCBSNC). It would be our pleasure to help you navigate through the Health Care Reform changes in accordance with the new regulations of Obamacare. Call us for details.


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