Qualifying Event

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A qualifying event can be anything that starts the terms of your insurance policy, for example by paying a premium or reaching a certain date.qualifying event

It can also be an event that occurs that enables you to determine a change in the way your insurance policies benefits during the course of your coverage.

In health insurance terms it may also be a specific event that might normally result in the cessation of an individual’s group health coverage but under the Consolidated Omnibus Budget Reconciliation Act (COBRA) that enable the individual to continue their coverage for a limited period of time. Usually in these cases the employer will meet some of the financial obligation for the continued coverage and the individual will meet the remaining financial obligation until end of the period of coverage which may be from between 18 and 36 months.

What kinds of qualifying events are there?

  • The first premium payment
  • The start date of your insurance policy
  • Change of your legal marital status – such as marriage, legally defined separation, annulment of the marriage, divorce or the death of a civil partner or spouse
  • A change in your dependents status – death, adoption, award of legal guardianship, birth and placement for adoption
  • Change in employment statuses – not just of the employee but also with respect to the policy holder’s spouse or dependents such as leaving employment, joining employment, switching from part-time to full-time or vice-versa, returning from unpaid leave, strikes or lockouts, etc.
  • A change in whether a dependent qualifies or fails to qualify for protection – such as marriage or a change of student status
  • A loss or gain of entitlement to Medicare benefits

How will I know what kinds of qualifying event apply to my insurance policies?

In general an insurer will want you to know what qualifying events apply or don’t apply to any particular type of insurance policy. The qualifying events of a policy, as such, will be laid out clearly in your insurance contract, and you should read the documentation thoroughly in order to determine exactly which qualifying events apply to your policy.

If you are still confused or uncertain about which qualifying events apply to your insurance policy or policies, you should get in touch with your insurance agent or insurance broker that sold you the policy and ask them to clarify.

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