Everything an Agent Should Know About Qualifying Life Events

Juliana Tom
Juliana Tom
Published on February 3, 2022

Learn more about what a qualifying life event is for health insurance.

You have likely heard the term “qualifying life event” many times, but do you know what it means and what exactly is a qualifying life event? It is a helpful term to understand when selling health insurance. 

If you know all about qualifying life events, you will be better able to find the right customers who need your services at the right time in their life. Being able to target your marketing and sales efforts to people who need health insurance makes you more efficient and saves you time. 

Read on to learn all about qualifying life events and how to identify when your customers are experiencing one, then reach out to us at American Senior Benefits to learn more. 

What Is a Qualifying Life Event? 

A qualifying life event is considered by health insurers as a change in someone’s life situation that causes them to be eligible for a special health insurance enrollment period. It is important as an agent to know what can be considered a qualifying life event because you can help your clients enroll if they experience one. 

Qualifying life events can include: 

  • A loss of current health insurance through work or a student who ages out of a school plan
  • A student who turns 26 and was previously covered by their parent or guardian’s health insurance plan 
  • Someone who loses their eligibility for Medicare, Medicaid, or Child Health Plus benefits for any reason 
  • The birth or adoption of a child 
  • Marriage 
  • A divorce that results in the loss of health insurance. Note that divorce alone is not a qualifying life event — the affected individual also must lose their health insurance because of the divorce to qualify. 
  • Relocating from one state to another or one zip code to another 
  • A student who moves away from where they attended school 
  • The death of the current policyholder 
  • Income changes that affect eligibility for income-based health insurance 

Important Things To Remember About Qualifying Life Events 

When talking with your clients about their qualifying life event, it is important to ask the date of the life event. Many qualifying life events must have occurred in the last sixty days to count as a qualifying life event. For example, a child being born could be considered a qualifying life event, but the birth must have been within the last sixty days. 

Coverage can be backdated to start on the date of the event, but the individual must apply within sixty days. Make sure to share this important timing detail with your customers and potential clients who have experienced a potential qualifying life event. 

If a person has moved and therefore needs new health insurance, they have to prove they had prior coverage for at least one day at their last residence to qualify. This condition does not apply to people who have relocated from another country. 

How To Help Your Clients With Qualifying Life Events

First, talk with your customers often to learn if they have experienced a qualifying life event. If you learn of one, reach out to your customer to talk about their health insurance needs. Discuss how they may be eligible for a special enrollment period within sixty days of the qualifying life event — and then help them find new coverage to best meet their changing needs. 

Be proactive and help your customers when they have a change in their life to find the most beneficial health insurance plan for their new needs. 

How Do I Learn More?

To learn more about qualifying life events, contact us at American Senior Benefits. Our affiliated experts will be happy to answer any questions you have. 

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