Eventos de vida que califican para el seguro de salud

Understanding Qualifying Life Events and Health Insurance

 

Hay momentos en que la vida cambia de forma inesperada. And when it does, those changes may occur outside the yearly Open Enrollment Period. Para dar respuesta a estos cambios inesperados, los periodos de inscripción especial garantizan que siempre recibas cobertura de seguro médico esencial durante los eventos de la vida que califican. 

 

To make sure you have the opportunity to purchase coverage during those times, a Special Enrollment Period allows you to enroll in essential health insurance coverage during qualifying life events. 

What Is A Qualifying Life Event?

 

Certain changes in your life situation are known as qualifying life events - things like a loss of health coverage, a change in your household, or a change in residence. These qualifying events give you the opportunity to sign up for a new health insurance plan or change an existing health insurance plan outside the Open Enrollment Period.

 

Los eventos de la vida que califican por lo general incluyen los siguientes, entre otros:

  • Becoming newly married or divorced.

  • Having a baby or adopting a child.

  • Experiencing a death of the insurer in the family.

  • Losing health insurance coverage due to job loss.

  • Losing eligibility for Medicare, Medicaid, or Children’s Health Insurance Program (CHIP).

  • Turning 26 and losing coverage from your parent’s health insurance plan.

  • Moving to a different zip code or county that changes your health plan area.

Because every situation is different, you may need to present documentation to show how the life event impacts your health insurance coverage. 

 

How A Qualifying Life Event Works

 

Your health insurance provider gives you the chance to make changes to your health insurance plan typically up to 60 days after a qualifying life event. These exceptions help you make necessary updates to your health insurance coverage due to special circumstances. To determine your eligibility for a qualifying life event, notify your health insurance provider as soon as these circumstances happen.

 

What Kind Of Documents Do I Need For A Qualifying Life Event?

Documentation often depends on the event and could include:

  • Birth certificates, adoption records, and marriage licenses that show you have added family members and need to modify your health insurance coverage.

  • Divorce papers or death certificates that show family members who provided health insurance have left you without coverage.

  • New rental agreements or mortgages that show you have moved into a new health insurance plan area.

Estos son solo algunos de los tipos de documentos que podrías necesitar. Si crees que estás atravesando un evento de la vida que califica, habla con tu proveedor de seguro médico para saber qué documentos necesitas para calificar.

 

What If I Do Not Qualify For A Special Enrollment Period?

 

Algunos eventos que cambian tu vida no se consideran eventos que califican. But you have options if you do not qualify. For example, you may be able to:

  • Apply for Medicaid. If you need health insurance and qualify, Medicaid accepts applications year-round.

  • Solicita soluciones de seguro médico alternativas. Specialized health insurance plans like Anthem Enhanced Choice1 are designed to provide coverage during changing life situations. Estos planes brindan cobertura integral y no están restringidos por periodos de inscripción. 

You deserve to feel confident that your health is covered and protected when you have a life-changing event. Qualifying events for insurance are not always clearly defined. That's why Anthem is here to help you understand if your life event changes your health insurance coverage and any options you have. Anthem can help you review your best options for consistent health plan protection through all of life's changes.

 

1Anthem Enhanced Choice coverage is not required to comply with certain federal market requirements for health insurance, principally those contained in the Affordable Care Act. Be sure to check your policy carefully to make sure you are aware of any exclusions or limitations regarding coverage of preexisting conditions or health benefits (such as hospitalization, emergency services, maternity care, preventive care, prescription drugs, and mental health and substance use disorder services). En la póliza también encontrará los límites de por vida y/o de pago anual de los beneficios de salud. Si esta cobertura caduca o pierdes la elegibilidad para ella, tendrás que esperar hasta que haya un periodo de inscripción abierta para obtener otra cobertura de seguro médico.

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