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.
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.
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.
There’s a long list of Qualifying Life Events, but they mostly fall into one of the following categories:
These are changes to an employee’s household status, such as:
Changes to an employee’s residence cover updates to their physical address. There can be several possible causes for such changes, including:
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:
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:
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:
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