Qualifying life events for health insurance
A qualifying life event is a change in your household, residence, income, coverage status, or other circumstances that may affect your eligibility for health insurance. These major life changes can trigger a special enrollment period, which allows you to enroll in or change your coverage outside the annual Open Enrollment period.
If you need coverage after Open Enrollment, UPMC Health Plan offers high-quality plans with access to routine checkups, mental health support, chronic condition management, and more.
What is a qualifying life event for health insurance?
A qualifying event for health insurance is a big change in your life that allows you to enroll in a plan outside of the yearly Open Enrollment period. In most cases, you have 60 days from the date of the qualifying life event to enroll in a new health insurance plan. If you are already enrolled and experience a qualifying life event, you may be limited to changing your metal level during the benefit year.
What happens when Open Enrollment ends?
If Open Enrollment has ended, you may still be able to enroll in a plan. Please read below to determine if you've experienced a qualifying life event that makes you eligible to buy health insurance during a special enrollment period.
How do I qualify for a special enrollment period?
You need to experience a qualifying life event to trigger a special enrollment period for health insurance. You typically have 60 days from the date of the qualifying life event to enroll in a new health insurance plan. If you are already enrolled and have experienced a qualifying life event, you may be limited to changing your metal level during the benefit year. In most cases, you will have to provide documentation of your qualifying life event.
Types of qualifying life events
You are eligible to enroll during a special enrollment period if, in the past 60 days, you experienced a qualifying life event, such as:
- A change in your household: Gained or lost a dependent due to marriage, divorce, birth, adoption, or foster care placement.
- Experiencing other qualifying life events: Received a court order that affects your insurance coverage (for example, a divorce decree or custody order), gained citizenship or lawful presence in the United States, or were released from incarceration.
- Losing your health coverage: Lost minimum essential coverage, including losing a job-based plan, aging out of a parent’s coverage at 26, losing coverage through divorce, or losing your eligibility for Medicaid or Children’s Health Insurance Program (CHIP) coverage in the past 90 days or next 60 days.
- Changing your residence: Permanently moved into the service area.
**To learn more about qualifying life events you can contact our sales team at 1-877-563-0292(TTY: 711) or visit UPMC Health Plan Marketplace
How do I enroll in a plan after a qualifying life event?
To enroll in a health plan after you experience a qualifying life event, follow these steps:
- Gather acceptable documentation to submit with your application.
- Explore high-quality coverage options from UPMC Health Plan.
- Enroll in a plan within your special enrollment period.
What kind of documents do I need for a qualifying life event?
To complete your application for coverage, you must submit acceptable documentation that verifies your qualifying life event:
- Marriage certificate
- Birth or adoption records
- Proof of health coverage loss
- Proof of address change
Need help after a qualifying life event?
To inquire about your eligibility for a special enrollment period for health insurance or to enroll, call a UPMC Health Plan licensed Sales representative at 1-877-563-0292 (TTY: 711). Our team members are knowledgeable about all UPMC Health Plan products and are happy to help you make benefit plan decisions, whether you choose to enroll directly through the Health Plan or through Pennie®, Pennsylvania’s health insurance marketplace.