“What is a Qualifying Life Event?” is a great question, and one we get often. Outside of the annual Open Enrollment period, you can't typically make changes to your health plan unless you experience a Qualifying Life Event (QLE). A QLE is a significant change in your life that allows you to make adjustments to your benefits, ensuring your coverage still meets your needs.
What's Considered a Qualifying Life Event?
Qualifying Life Events usually fall into a few main categories:
- Changes in Household: This includes getting married, divorced, or legally separated. It also covers the birth or adoption of a child, or the death of a family member on your plan.
- Changes in Residence: Moving to a new ZIP code, county, or state where your current plan is not available is a QLE. This also applies to students moving for school or a seasonal worker moving for a job.
- Loss of Other Coverage: If you or a dependent loses other health coverage, that's a QLE. Common examples include losing job-based coverage, aging off a parent's plan at age 26, or losing eligibility for a government program like Medicaid.
- Other Events: This can include a change in your employment status that impacts your eligibility for coverage or even a change in citizenship status.
The Importance of Timely Updates
It's critical to report your QLE to HR as soon as possible. You generally have a special enrollment period of about 30 to 60 days from the date of the event to make changes to your benefits. If you miss this window, you will have to wait until the next Open Enrollment period to make changes unless you have another qualifying event.
The sooner you notify HR, the sooner we can work with you to update your coverage and prevent any gaps or issues with your claims. On occasion, You may need to provide documentation to verify the event, such as a marriage certificate, birth certificate, or a letter from your previous employer about the loss of coverage.
Can I Change My Plan or Just Add/Remove People?
A QLE allows you to make changes that are consistent with the event. For example:
- Gaining a dependent (like getting married or having a baby) gives you the opportunity to add that new person to your existing plan. You can also choose to enroll in a different plan that better fits your new family size, such as switching from a single plan to a family plan.
- Losing a dependent (like due to divorce or death) allows you to remove that person and adjust your plan accordingly, potentially switching to a less expensive one.
- Losing coverage due to a move or job change allows you to enroll in a new plan entirely.
In most cases, if you're just adding or removing a dependent, you can keep your current plan and simply update your enrollment. However, if your needs have changed significantly, a QLE provides a rare opportunity to review all your options and potentially switch to a different plan altogether.