Do You Have to Wait Until Open Enrollment to Add a Spouse?
Understand the circumstances and steps for adding a spouse to your health insurance plan beyond annual open enrollment.
Health insurance enrollment typically occurs during a specific period each year, known as open enrollment. This is the designated time when individuals can enroll in a new health plan or make changes to an existing one. While open enrollment is the primary opportunity to adjust coverage, certain life events, such as marriage, allow for immediate changes, including adding a spouse.
Special Enrollment Periods
Individuals generally cannot enroll in or change their health insurance coverage outside of the annual open enrollment period. However, a Special Enrollment Period (SEP) provides an exception. An SEP allows individuals and their families to enroll in a new health plan or modify their current one due to specific qualifying life events.
SEPs are available for both employer-sponsored health plans and plans obtained through the Health Insurance Marketplace. These periods provide a limited window, often 30 to 60 days from the date of the qualifying event, during which individuals can make changes to their coverage. Acting promptly within this timeframe is important to ensure continuous coverage for the newly added spouse.
Common Qualifying Life Events for Spouses
Several common life events can trigger a Special Enrollment Period, allowing an individual to add a spouse to their health insurance plan. One of the most frequent qualifying events is marriage; the ceremony date initiates the SEP during which the newly wedded spouse can be added to a health plan.
Another common qualifying life event involves the loss of other health coverage by the spouse. This can occur for various reasons, such as job loss, the expiration of COBRA benefits, or aging off a parent’s health plan. The loss of coverage must be considered “qualifying,” meaning it generally cannot be due to a failure to pay premiums or a voluntary termination of coverage.
A change in residence can also sometimes trigger an SEP, particularly if the move places the policyholder or their spouse in a new service area where their current plan is unavailable. For all these events, it is important to act within the typical 30- to 60-day window following the qualifying event to ensure eligibility.
The Process of Adding Your Spouse
Adding a spouse to your health insurance plan after a qualifying life event involves several key steps. You will typically need to provide documentation that verifies the qualifying event, such as a marriage certificate or a letter from your spouse’s previous insurer or employer confirming the termination of their coverage. You will also need your spouse’s personal details, including their full legal name, date of birth, and Social Security number, to complete the enrollment.
The submission process varies depending on whether your health insurance is employer-sponsored or obtained through the Health Insurance Marketplace. For employer-sponsored plans, you should contact your company’s human resources department or benefits administrator. They will provide the necessary forms and guide you through the specific requirements for submitting your documentation and enrolling your spouse.
If you have a plan through the Health Insurance Marketplace, you will typically report the qualifying life event through your online account or by contacting their customer service. After verifying the event, the Marketplace will open a Special Enrollment Period, allowing you to add your spouse to your existing plan or select a new plan if necessary. Following submission, you will generally receive confirmation of enrollment, and coverage for your spouse often begins on the first day of the month after the qualifying event, provided you reported it within the designated timeframe.