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

Employer-provided insurance and benefit 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, but they normally occur before a new plan year begins on January 1.

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. 

Qualifying Life Event Types

There’s a long list of Qualifying Life Events, but they mostly fall into one of the following categories:

Changes in Household

These are changes to an employee’s household status, such as:

  • Marriage or divorce
  • Birth or adoption of a child
  • Death in the family

Changes in Residence

Changes to an employee’s residence cover updates to their physical address. There can be several possible causes for such changes, including:

  • Moving to a new ZIP code or county.
  • A seasonal worker moving to or from the area in which they currently work.
  • Moving to or from a shelter or temporary housing.
  • A student moving to or from their school.

Loss of Health Insurance

These are situations in which an individual’s coverage is through someone else’s insurance plan (e.g., a spouse, a parent, etc.), and that coverage ends, such as:

  • A person loses Medicare, Medicaid, or the Children’s Health Insurance Program (CHIP) eligibility for whatever reason.
  • A child loses coverage from a parent’s insurance when that child turns 26.
  • An individual loses coverage due to their spouse or partner losing their job.

Other Qualifying Events

To account for all other QLEs that don’t fit into the categories above, there’s also an “Other” category that covers a wide range of events, including:

  • Changes to personal income that affect coverage eligibility.
  • Being released from prison.
  • Becoming a U.S. citizen.
  • Becoming a member of a federally recognized tribe.

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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