Open Enrollment happens once a year, from October 15 to December 15. It’s your annual window to enroll in a new plan or make changes to your existing coverage. But what happens when life doesn’t stick to the schedule?
A new baby, a new address, or a new marriage—these moments don’t wait for Open Enrollment, and neither should your health coverage. That’s where Qualifying Life Events (QLE) and Special Enrollment Periods (SEP) come in.
If you already have insurance through Your Health Idaho, a QLE could allow you to change your coverage options. It can also impact your financial eligibility, which means you could qualify for a new or updated tax credit amount. If you don’t already have insurance, it will allow you to enroll in new health coverage before Open Enrollment.
What is a Qualifying Life Event?
A QLE is a major life change that affects your health Insurance needs. Common QLEs include:
Loss of coverage
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- Loss of employer or spouse’s employer coverage
- Loss of student health plan
- Turning 26 and aging out of your parents’ or guardians’ health insurance plan
- Exhaustion of employer-sponsored COBRA or PERSI benefits
Changes in the household
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- Getting married
- Getting divorced
- Having a baby
- Adopting a child
- Court appointment of a ward
- Becoming a foster parent
- Death of the primary subscriber
- Loss of government coverage, such as Medicaid, CHIP, Medicare, Tricare, or Peace Corps coverage
Changes in residence
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- Moving to Idaho
- Moving within Idaho to a new coverage area
- Moving from another country
Other QLEs
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- Gaining citizenship or lawful presence
- Employer coverage is considered unaffordable
- Changes in income that affect tax credit eligibility
- Other special circumstances
What is a Special Enrollment Period?
A SEP is a 60-day window that opens after a QLE takes place. During this time, you can enroll in a health plan for the first time, switch to a different plan, or add or remove family members from your coverage.
A 90-day window opens only for the following QLE:
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- Loss of government coverage, such as Medicaid, CHIP, Medicare, Tricare, or Peace Corps coverage
If you miss the SEP enrollment window, you will likely have to wait until the next Open Enrollment unless another QLE occurs.
To determine if you qualify for an SEP, visit our special enrollment page, contact our Customer Support Center at 855-944-3246 or chat live at YourHealthIdaho.org.
When discussing your eligibility for an SEP, you may be asked to provide verification documents.
Verification documents may include:
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- Valid Idaho driver’s license or Idaho identification card
- Marriage certificate
- Death certificate
- Birth certificate
- Certificate of adoption
- Letter explaining loss of coverage
- Proof of address
- Proof of qualifying coverage from employer or insurance carrier
- Documentation of employer Open Enrollment demonstrating an offer of unaffordable coverage
- Proof of prior insurance
- And others, depending on the QLE
Tribal Members Enrollment Periods
If you’re a member of a federally recognized American Indian tribe or an Alaska Native Claims Settlement ACT (ANCSA) shareholder, you have additional flexibility when enrolling in coverage outside of Open Enrollment.
You will need to provide your Tribal membership document or ANCSA shareholder documentation. You can enroll at any time during the year, or change plans once a month, without needing a referral from Indian Health Service or Tribal providers.
Life Happens. We’re Here to Help
Marriage, a new baby, a change in address, or a job change, life keeps moving. When it does, your health coverage should move with it. Don’t wait for Open Enrollment. See if you qualify for an SEP today and get quality health coverage with Your Health Idaho.
Remember, you have 60 days to report most QLEs and 90 days for loss of government coverage, provide documentation, make changes, and enroll in a plan.
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- If you have or previously had insurance through Your Health Idaho, log in to your account to edit your application
- If you are new to Your Health Idaho, create an account
If you have questions or would like more information, contact one of our Idaho-based Customer Advocates at 855-944-3246 or chat live at YourHealthIdaho.org.
You can also visit the Find Help page to find a local certified agent whose assistance is available to you at no cost. The agents are experts who can walk you through the application process, assist you in applying for a tax credit, and help you choose and manage your plan.