Once your new hire enrollment or open enrollment period ends, your benefit elections are locked in until the next open enrollment period. In order to make changes to your benefits outside of open enrollment, you will need a qualifying life event to occur. A qualifying life event opens up a special enrollment period for you to enroll in, change or cancel your current benefits.
What is a Qualifying Life Event?
A qualifying life event is an event like getting married, divorced, the birth of a child, a loss of coverage or other event that changes your situation. Qualified life events are often referred to QLE’s for short.
Qualifying Life Event Examples
Here are few examples of qualifying life events:
- Gain or loss of coverage
- Marriage
- Divorce
- Legal separation
- Birth
- Adoption or placement for adoption
- Death of a spouse
- Death of a dependent
- Dependent attains age 26
These are just some of the most common examples of qualifying life events. You’ll want to check with your employer if you have any questions about what is and what is not a qualifying life event.
Who Governs Qualifying Life Events?
Qualifying life events are governed first by the Health Insurance Portability and Accountability Act Special Enrollment Rights. HIPAA requires certain qualifying life events by law to provide special enrollment rights. However, additional optional qualifying life events may be allowed by an employer. These would be outlined in the IRS Code Section 125 plan documents and the insurance company policies.
Qualifying Life Event Changes Must Be Approved by Your Employer
Once you have a qualifying life event, your qualifying life event change must be verified and approved by your employer. You’ll need to check with your employer and ask them what you need to do to get your qualifying life event approved.
Why Employers Must Verify and Document Your Qualifying Life Event
Even though an employer might want to approve your qualifying life event, they must follow the law. If they do not comply with the law, they risk having their plan disqualified as well open both themselves and you to fines and penalties. This is why your employer will need to make sure your qualifying event complies with the rules of their plan ask for documentation to verify your qualifying life event.
Qualifying Life Event Documentation
Here is a list of the typical types of documentation you may need to provide to your employer to prove you are eligible for a qualifying life event.
| Event | Documentation |
| Marriage | Marriage certificate showing date of marriage |
| Divorce | Divorce decree |
| Legal separation | Court order |
| Death of a family member | Certified death certificate |
| Birth of a child | Birth certificate, application for birth certificate or letter from hospital that lists date of birth. |
| Adoption | Court order |
| Loss of coverage | Letter from employer, health insurance company or government entity showing when coverage ended or will end. |
Double check with your employer to see what documentation they need.
30 Day Enrollment Period
You have 30 days to request and process your qualifying life event.
Effective Date of a Qualifying Life Event Change
Plan effective dates for changes during a qualified life event enrollment may vary by employer. Generally, the effective date will be:
- Birth or adoption of a child: Date of birth or adoption
- All other qualifying life events: First of the month following the event.
Some employers may allow the effective date to be backdated to the day you lose other coverage so you won’t have a gap in coverage.
Frequently Asked Questions about Qualifying Life Events
Here are some of the most frequently asked questions about qualifying life events:
- Is getting pregnant a qualifying life event? Getting pregnant is not a qualifying life event. Once the baby is born is a qualifying life event. You’ll be able to add your child to your health insurance effective the date they are born.
- Does moving count as a qualifying life event? Moving may count as a qualifying life event but you’ll need to check with your employer to confirm.
- Is a furlough or reduction in income a qualifying life event? A reduction in income may count as a qualifying life event but you’ll need to check with your employer to confirm.
- Is my spouse’s open enrollment a qualifying life event? A spouse’s open enrollment may be a qualifying life event for you but that will depend on your employer.
- Is a domestic partnership or common law marriage a qualifying life event? You’ll need to check with your employer to confirm whether these events would open up a special enrollment.
Qualifying life events can be tricky. Some qualifying life events approvals are optional by the employer. That’s why you’ll need to check with your employer to see if they can approve your event.
Other Post-Tax Benefit Changes Outside Open Enrollment
Qualifying life events primarily dictate enrollment changes in the pre-tax benefits of health, dental, vision insurance as well as flexible spending accounts (FSA’s). However, a qualifying life event may open enrollment options in the post-tax benefits.
But even without a qualifying life event, you may be able to drop post tax benefits at any time of year. This will be at the discretion of your employer. Employers sometimes allow cancellations of post-tax benefits any time of year while others only allow them at open enrollment.
Conclusion
If you have a qualifying life event, you can qualify for a special enrollment to enroll in, change or cancel your current benefit elections. If you think you qualify for a qualifying life event change, you’ll need to work with your employer to verify and document the change. Once approved you’ll have 30 days to make your enrollment change. The effective date of coverage will usually be the date of birth for the birth of child and the first of the month following the event for all other QLE’s.
So now you know what qualifying life event changes are and how they work. Be sure to check with your employer for more details. If you an employer, you’ll need to work with your legal counsel, the insurance companies, your brokers and enrollment partners to set up a compliant process to handle your qualifying life events.
