What’s a Qualifying Life Event?

In the event of a qualifying life event (QLE), employees qualify to make changes in their current benefits selection. Are you eligible?


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Marriage as a qualifying life event

As open enrollment season quickly approaches, there’s a lot on the minds of your employees. New plans, dates, deadlines, out of pocket expenses and other unfamiliar jargon are all up for reexamination. Benefits enrollment can be an overwhelming process, but it doesn’t have to be. To help your employees through a smooth enrollment process, provide them with explanations of what certain terminology means so they feel fully in the driver’s seat. While this won’t apply to all of your employees, offering information about Qualifying Life Events, or QLEs, will be helpful should an employee have experienced a major life change and need to make modifications to their benefits plan outside of the company’s open enrollment cycle. Continue reading for a breakdown of the types of QLEs, how to provide proof of said change, and steps needed to take in order to make adjustments during a special enrollment period.

What is a Special Enrollment Period?

A special enrollment period is a timeframe in which an employee can modify their current enrollment selections to adjust for any change that may have occurred. Typically, individuals have 60 days to make adjustments to their coverage following the QLE date.

What constitutes a qualifying life event (QLE)?

If any of the following life events have occurred for you recently, you are eligible to make changes to your existing benefits plan:

Change in employment status

  • If an employee or an employee’s dependent undergoes a change in employment status that includes a) getting hired b) quitting a job or being laid off c) converting from part to full-time employment.
  • This type of change is considered a loss of coverage QLE and the effective date for coverage will be backdated to the date that coverage officially terminated.

Change in marital status

  • If an employee gets married, he/she can add their spouse to their insurance policy within 30 days of the marriage date.
  • If an employee gets divorced and needs to either remove a dependent or enroll in their own insurance independently, they can enroll within 30 days of the divorce finalization date.

Having a baby or adopting a child

  • If an employee has a baby or adopts a child, they can usually add their child to their insurance policy within 30 days of birth.

An international move to the U.S.

  • Did you just relocate to the U.S.? If an employee and their dependents move into the U.S., they are qualified to join a plan under a QLE with a passport stamp made in the last 30 days.

Turning 26

  • If an employee or an employee’s child “ages out” of their current coverage due to turning 26, he/she is eligible for a QLE, and their coverage will be backdated to the date that their coverage officially terminated (their 26th birthday).

Loss of a dependent

  • If a dependent passes away, you are eligible to make changes to your existing coverage plan through a qualifying life event.

Spousal open enrollment

  • If an employee has a spouse going through open enrollment, that counts as a qualifying life event. For instance, if an employee’s spouse declines their own insurance to opt into your employees’, they are eligible to be added as a dependent.

Declining marketplace insurance

  • Declining individual marketplace open enrollment coverage is considered a qualifying life event to enroll in company coverage by many carriers. Please contact your insurance carrier for final confirmation on whether it is considered a QLE.

Back up, remind me what open enrollment is?

Open enrollment is the 45-day window where employees have the opportunity to sign up for coverage or make modifications to their existing health care coverage through their employer. Open enrollment is a crucial time to be prepared for, as you want to ensure you’re happy with your current plan or that you have an idea for adjustments you’d like to make. Open enrollment can take part at any time of year, really, but typically, most employers commence their OE during the fall months.

How long do I have to act on a qualifying life event?

Typically, you will have 60 days from the date of the QLE to make amendments to your current benefits plan. So, if you turned 26 on April 25th, 2018, that is the date that commences your 60 day window to make selections in your new benefits plan. If you got married on May 1st, the same applies.

And, just so we’re clear, is a new job a qualifying life event?

Yes. When you join a new employer, you will go through an onboarding process that will allow you to make selections based on your current needs. If you plan to be a dependent on your parents’ plan or that of a spouse, you can decline coverage at this time.

If you qualify for a special enrollment period based on the qualifications above, contact your HR department to understand how you can commence making changes based off of your QLE.


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