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Qualifying Life Events

Special Enrollment Periods (Qualifying Life Events)

If you miss Open Enrollment, you may still be able to enroll or change plans after certain major life events. These are called Qualifying Life Events (QLEs).

Most Special Enrollment Periods last 60 days from the date of the event.

You may need to provide documents to confirm your life event.

If you get married, you may be able to enroll in coverage or change your plan. Either you or your spouse must have had coverage in the 60 days prior to your special enrollment period.

You usually have 60 days after your marriage to make changes.

Your new coverage will usually start the first day of the next month.

You may need:

  • A marriage certificate
  • Proof of prior coverage​

You can add a new child to your health plan after:

  • Birth
  • Adoption
  • Placement in foster care or guardianship

You usually have 60 days to update your coverage.

Coverage can start on the date of the child's birth, adoption, or placement.

You may need:

  • A birth certificate
  • Adoption papers
  • Court documents ​

You may qualify if you lose health coverage through:

  • A job
  • COBRA
  • Oregon Health Plan (OHP)
  • A parent's health plan
  • Student health coverage

You can apply:

  • Up to 60 days before coverage ends, or
  • Within 60 days after coverage ends

Your new coverage usually starts the first day of the next month.

You may need:

  • A letter showing when your coverage ended

Important

You may not qualify if:

  • You canceled your coverage yourself
  • Your coverage ended because premiums were not paid
  • You did not complete required paperwork
  • Your coverage was through a health sharing ministry or other non-compliant entity​

You may qualify if you move:

  • To Oregon from another state
  • To a new county or ZIP code in Oregon

You may need:

  • Proof of your move
  • Proof you had health coverage before moving

Coverage usually starts the first day of the month after you enroll.​

You may qualify for a Special Enrollment Period if:

  • You get divorced or legally separated
  • Someone on your health plan dies
  • You lose health coverage because of the change

You may need:

  • Court documents
  • A death certificate
  • Proof that coverage ended ​

If you gain an eligible immigration status, you may qualify to enroll in coverage outside Open Enrollment.

You may need:

  • Immigration documents showing your new status

Coverage usually starts the first day of the next month.​

If you are released from jail or prison, you may qualify to enroll in health coverage.

You usually have 60 days after your release to enroll.

You may need:

  • Release paperwork ​


If you lose OHP coverage, you may qualify for a Special Enrollment Period.

You can apply:

  • Up to 60 days before your OHP ends, or
  • Within 90 days after it ends

You may need:

  • A notice showing when OHP coverage ended ​


Survivors of domestic violence may qualify for a Special Enrollment Period.

Only self-attestation is required as proof.​


Situations that usually do NOT qualify

You usually will not qualify for a Special Enrollment Period if:

  • You choose to cancel your coverage
  • Your coverage ends because you did not pay premiums
  • Your income changes but your eligibility does not change
  • You miss deadlines to provide required documents

Exceptional Circumstances

Sometimes major unexpected events can prevent someone from enrolling on time.

Explore Health may offer special enrollment help for situations like:

  • Natural disasters
  • Technical problems
  • Enrollment mistakes
  • Domestic violence situations
  • Delayed agency decisions

Each situation is reviewed individually.

If you think you missed enrollment because of a major life event or special circumstance, contact Explore Health for help.