Life Events
When a life-changing event happens — whether planned or unexpected — your health plan may need to change as well. With qualifying life events, you can make the changes you need without waiting for an open enrollment period.
Your special enrollment period
Anyone can enroll in an individual health insurance plan during open enrollment. But life doesn’t always wait for an open enrollment period to happen. If you recently got married or had a baby, you will likely need to make changes to your health plan. These are situations called qualifying life events, and they allow you to change your health coverage outside of an open enrollment period, also known as a special enrollment period.
In most situations, you have a limited amount of time to make these changes. Missing this deadline could mean having to wait until the next open enrollment period and potentially being without coverage for up to a year. You may be asked to provide proof of the qualifying event when you request a change.
If you're not sure you qualify for a special enrollment period, you can visit HealthCare.gov External Site and find out. If you are on a Wellmark grandfathered or grandmothered plan and have a qualifying life event, contact your authorized Wellmark agent or Customer Service at the phone number listed on the back of your ID card.
Qualifying life events
Involuntary loss of coverage
Sometimes things happen unexpectedly and you need to change your coverage.
Happy birthday! If you are about to or just turned 26 and have been on your parent's health plan, you will need your own coverage. You may have the option of enrolling in employer-based insurance. Or, you may choose a Wellmark health plan on the Health Insurance Marketplace® (HealthCare.gov).
Your special enrollment period is 60 days before and after you turn 26. Contact your authorized Wellmark agent to enroll or shop individual plans online.
Enrollment and effective dates vary by event and you may be asked to provide proof of the qualifying event.
When you experience a major shift in your family life, your coverage may need to change.
Your special enrollment period is 60 days before and after the event. Contact your authorized Wellmark agent to enroll or shop individual plans online.
Enrollment and effective dates vary by event and you may be asked to provide proof of the qualifying event.
We're sorry for your loss. With the loss of your plan's policyholder, you will need to adjust your health plan.
Your special enrollment period is within 60 days of the passing. Contact your authorized Wellmark agent to enroll or shop individual plans online.
Enrollment and effective dates vary by event and you may be asked to provide proof of the qualifying event.
A change in employment status is a qualifying life event, whether you changed employers or you lost coverage due to a layoff, dismissal, resignation or retirement.
Your special enrollment period is within 60 days of the employment status change. Contact your authorized Wellmark agent to enroll or shop individual plans online.
Enrollment and effective dates vary by event and you may be asked to provide proof of the qualifying event.
If your plan’s policyholder enrolled in other coverage, such as Medicare, Medicaid, Medicare supplement, Medicare Advantage, Veteran Affairs (VA) coverage, TRICARE or group coverage, you will need your own coverage. You may have the option of enrolling in employer-based insurance. Or, you may choose a Wellmark health plan on the Health Insurance Marketplace (HealthCare.gov External Site).
Your special enrollment period is 60 days before or after the policyholder's coverage ends. Contact your authorized Wellmark agent to enroll or shop individual plans online.
Enrollment and effective dates vary by event and you may be asked to provide proof of the qualifying event.
Adding a dependent
Some life events may call for you to add someone to your plan. These are the qualifying events.
Congratulations! Welcoming a new baby is an exciting time, but it can also be exhausting. Don't forget to change your coverage during the special enrollment period to ensure your new bundle of joy is covered.
Your special enrollment period is 60 days before or after the birth of your baby. Contact your authorized Wellmark agent to enroll or shop individual plans online.
Enrollment and effective dates vary by event and you may be asked to provide proof of the qualifying event.
What an exciting time, congratulations! With the newest addition to your family, you will need to change your coverage.
Your special enrollment period is 60 days before or after the adoption date. Contact your authorized Wellmark agent to enroll or shop individual plans online.
Enrollment and effective dates vary by event and you may be asked to provide proof of the qualifying event.
Congrats to the couple! Along with making sure you are covered, you will want to ensure your new spouse is covered, too.
Your special enrollment period is 60 days before or after your marriage. Contact your authorized Wellmark agent to enroll or shop individual plans online.
Enrollment and effective dates vary by event and you may be asked to provide proof of the qualifying event.
If you've received a court order to add a dependent, you may be looking for health coverage options. We can help.
Your special enrollment period is 60 days before or after the order. Contact your authorized Wellmark agent to enroll or shop individual plans online.
Enrollment and effective dates vary by event and you may be asked to provide proof of the qualifying event.
Need help paying for your individual health plan?
Individual and family health insurance coverage may be available to you at a reduced or no cost, depending on your household income. The cutoff limits differ by state and are dependent on the federal poverty level.
There are two kinds of subsidies available from the federal government for individual and family health insurance plans:
- The Advanced Premium Tax Credit lowers your monthly health insurance premium.
- Cost Sharing Reduction reduces the amount you pay on deductibles, coinsurance and copays, which lowers your total out-of-pocket costs during a policy period.
To find out if you are eligible to save on a Health Insurance Marketplace plan, visit HealthCare.gov External Site.
