Qualifying Life Event (QLE)
Summary Definition: A significant change in an employee’s life that allows them to enroll in or make changes to health insurance benefits outside the normal open enrollment period.
What is a Qualifying Life Event (QLE)?
A Qualifying Life Event (QLE) is a health insurance term for when an employee’s life changes so drastically they’re allowed to enroll in or alter current health insurance benefits, even if the event occurs outside the normal open enrollment period.
QLEs can include events such as marriage, divorce, moving to a new area, and the birth or adoption of a child.
Key Takeaways
- A Qualifying Life Event (QLE) is a life-changing event that allows employees to enroll in or modify health insurance benefits outside normal open enrollment periods.
- Common qualifying life events include marriage, divorce, childbirth, relocation to a new residence, etc.
- The Special Enrollment Period in which eligible employees are allowed to adjust health insurance benefits usually lasts up to 60 days after the QLE.
Special Enrollment Period (SEP)
Public and employer-provided insurance plans normally only allow employees to enroll or adjust existing enrollments during a specific window each year (a.k.a., Open Enrollment). Open enrollment dates can vary by organization and government program, but they normally occur before a new plan year begins on January 1. The Affordable Care Act (ACA), for example, has an enrollment window of November 1 - January 15.
When an employee experiences a QLE outside the open enrollment period, they’re given a Special Enrollment Period in which to make those same kinds of changes to their benefits and coverage. Employees typically have up to 60 days after the date of the qualifying life event to make any enrollment changes, but this can vary based on the type of qualifying event.
Qualifying Life Event Types
Participants and enrollees should consult their plan or program's specific guidance for a more comprehensive list of recognized QLEs, but some common categories include:
| Change Type | Change Details | Change Examples |
| Changes in Household | Changes to an employee’s household status |
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| Changes in Residence | Updates to an employee's physical address |
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| Loss of Health Insurance | An individual’s coverage through someone else’s insurance plan (e.g., a spouse, a parent, etc.) ends |
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| Other Qualifying Events | A wide range of miscellaneous events that don't fit in other categories |
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Qualifying Life Event Requirements
Depending on an individual’s plan and insurance provider, some documentation can be required to verify that the QLE occurred. For example, someone who gets married could need to provide their marriage certificate showing the event happened. This requirement can apply to other events and documents, such as:
- Death: Death Certificate
- Moving: Proof of residency from the old and new addresses
- Job Loss: Termination letter
- Divorce: Court-filled divorce papers
- Childbirth or Adoption: Birth certificate or adoption papers
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