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What is a “qualifying event”?

Each fall, there will be an open enrollment period for those who will be getting insurance through the HIX (Health Insurance Exchange). That enrollment period will cover insurance for the following year. For example, from October through December of 2014, you can enroll for insurance that will cover you during 2015.

This is to prevent individuals from “gaming the system” by going without insurance until they need it, and it’s very similar to what you’ve probably already experienced with your employer-based insurance.

However, there will also be special enrollment options throughout the year for individuals and families who become eligible for coverage in the marketplace due to a “qualifying event.” Some examples of qualifying events:

  • A change in income.
  • A change in your status, such as marriage, death of a spouse, divorce, legal separation or annulment.
  • A change in your number of dependents, including birth, death, adoption or placement for adoption.
  • A change in your employment status, or the employment status of your spouse or dependent.
  • A dependent becoming ineligible for existing coverage due to attainment of age.

You will have 60 days from the date of the qualifying event to secure new coverage without incurring a penalty.