What is a qualifying event?
A change in your life circumstances that would make you eligible to change or enroll in a new health plan during the Special Enrollment Period (SEP) is called a qualifying life event (QLE). Without a qualifying life event, individuals can only enroll in a new health plan during the annual Open Enrollment Period (OEP) which goes from Nov. 1 to Jan. 15. There are several QLEs set by the federal government, including marriage, loss of coverage from an employer and aging off a parent's plan.
Is having a baby a qualifying life event?
Yes, the birth of a child is a qualifying life event. Your 60-day special enrollment period will begin on the day of your child's birth, and you will need to provide a copy of the birth certificate to qualify. Coverage is usually retroactive to the date of birth, though it can begin on the first date of the following month if the person enrolling requests it.
Neither parent of the child needs to have existing health coverage to qualify for a Special Enrollment Period. If you're not currently covered, you can use the special enrollment as an opportunity to enroll in a plan, along with the child.
If you're already enrolled in a plan, you can add the child onto the existing plan at the same metal level, or they can be enrolled in a new plan at any metal level.
Some restrictions can apply to parents with existing plans that may prevent them from changing the metal of their plan. Rules concerning these issues can change, so it's a good idea to talk with a health plan expert to ensure you have the most recent information available.
Is pregnancy a qualifying life event for health coverage?
In Michigan, pregnancy is not considered a qualifying life event.
How to choose a plan
There are a wide range of health plans available on the Marketplace, and it can be challenging to know which one to choose. Selecting a health plan for you and your newborn baby is a significant decision, and you should make sure you have all the information you need.
Our Learning Center has a wealth of resources to help you understand the different health plans available and the language that is used to describe them. We also have enrollment specialists who can talk with you about the options available at Priority Health.
As you're shopping for an Individual and family health plan, be sure to keep several factors in mind:
- Any chronic health conditions you have
- Whether you currently take any prescription drugs
- How often you need to visit a doctor or specialist
- If it's important to you that you keep the same provider
- Additional benefits such as hearing aids or gym memberships
Why choose Priority Health?
We are a Michigan-based company that is deeply rooted in our community and we continue to be recognized as a leader in quality, customer service, transparency and product innovation. Our plans are centered around improving our member's health while keeping the cost affordable.
Priority Health has been providing high-quality health plans to Michigan residents for more than three decades. Our MyPriority® plans are built to help you take control of your health at an affordable price.
Our customers also have access to a mobile app that offers them an easy way to manage their health plan. They can view their personal information, find doctors, keep track of their spending and use tools to help them save money on the cost of care.
Talk to the experts at Priority Health
Are you looking to change health plans after the birth of a child? Reach out to the experts at Priority Health to talk about the right options for your family.
Frequently asked questions
When is open enrollment?
The annual Open Enrollment Period begins on Nov. 1 for health coverage for the following year. It's the first day you can enroll, re-enroll, or change your health plan. Dec. 15 is the last day you can enroll so your coverage begins Jan. 1. If you enroll between Dec. 16 and Jan 15, your coverage begins Feb. 1. After Jan. 15, you can only enroll or change your health coverage if you qualify for a Special Enrollment Period.
What are the other qualifying life events?
- Loss of qualifying health coverage
- COBRA coverage ending
- Foster care placement
- Moving to a different coverage area
- Gaining U.S. citizenship or qualified immigration status
- Aging off a parent's plan
- Losing eligibility for Medicaid or CHIP
- Death of the policyholder
Is adoption a qualifying life event?
Yes, both adoption and foster care placement are QLEs. The Special Enrollment Period will begin on the day of the adoption or placement and continue for 60 days. You will need to provide your adoption papers, placement orders or other proof of placement to enroll.
Health coverage 101
- How to save on health coverage
- How to compare health plans
- OEP checklist
- 5 step guide to shopping
- Take a quiz to find your plan
- 5 health plan terms to know
- What's a high-deductible plan?
- Understanding metal levels
- 6 Affordable Care Act key terms
- MyPriority plan benefits
- Chronic condition coverage
- 5 must haves in a plan
- Narrow Network plans
- Coverage for immigrants