Due to IRS guidelines, you cannot make changes to your health insurance benefits outside of your employer's annual open enrollment period unless you experience a qualifying life event (QLE).
A QLE is a change in your situation — like getting married, having a baby, or losing health coverage — that can make you eligible for a special enrollment period.
You have 30 days from the date of your qualifying event to submit your requested change to Human Resources (or your benefits administrator). You will be asked to include:
- Supporting documents (see "Required Documents" below), and
- The date the change occurred.
Outside of the special enrollment period, your only opportunity to make a change is during your company's annual open enrollment (or if you experience another qualifying life event).
Can I provide a QLE for a future change?
No, this question comes up a lot—specifically for those expecting a baby. You can solely submit a QLE for an event that has occurred, not a future date. It's useful to note that, specifically and for the birth of a child, coverage is always retroactively available as of the birth date. See the "QLE Effective Date" section at the bottom of this article for more details.
4 Basic Types of QLEs
The most common examples include:
Loss of health coverage
- Losing existing health coverage, including job-based, individual, and student plans
- Losing eligibility for Medicare, Medicaid, or CHIP
- Turning 26 and losing coverage through a parent’s plan
Changes in household
- Getting married or divorced
- Having a baby or adopting a child
- Death in the family
For employer-sponsored health plans, changes in residence *sometimes* qualify if the move means the employee no longer has coverage on their existing plan (example: Employee is on a California HMO, but moves to Texas).
- Moving to a different ZIP code or county
- A student moving to or from the place they attend school
- A seasonal worker moving to or from the place they both live and work
- Moving to or from a shelter or other transitional housing
Other qualifying events
- Changes in your income that affect the coverage you qualify for
- For a Dependent Care FSA, a change in the cost of services or your dependent's eligibility (for example, your child reaches age 13 and is no longer eligible under a DCFSA)
- Gaining membership in a federally recognized tribe or status as an Alaska Native Claims Settlement Act (ANCSA) Corporation shareholder
- Becoming a U.S. citizen
- Leaving incarceration (jail or prison)
- AmeriCorps members starting or ending their service
View the full list at HealthCare.gov.
Required Documents
Below are examples of qualifying life events and supporting documents.
| QLE Category | Type of Change | Supporting Documents |
| Legal Marital Status | Marriage | Marriage certificate |
| Divorce or annulment | Divorce decree/court ruling for annulment | |
| Legal separation | Court order of legal separation | |
| Death of spouse | Death certificate | |
| Number of Dependents | Birth | Birth certificate |
| Death | Death certificate | |
| Adoption/placement for adoption | Court order for adoption /placement for adoption | |
| Child aging off parent's plan (age 26) | COBRA letter, documentation from carrier, documentation from parent's employer on company letterhead | |
| Employment Status of Employee or Spouse | Loss of employment | Termination documents on company letterhead, COBRA letter, or unemployment application |
| Start of employment | Employer documentation on company letterhead with employment start date | |
| Change in worksite | Employer documentation on company letterhead showing change and impact on eligibility | |
| Leave of absence | Employer documentation on company letterhead stating employee has started or returned from leave | |
| Gain/Lose Eligibility for Other Group Coverage (HIPAA special enrollment) | Group health plan | Documentation from plan or carrier regarding change in eligibility with effective date |
| Employment status of Employee or Spouse | Loss of employment | Termination documents on company letterhead, COBRA letter, or unemployment application |
| Start of employment | Employer documentation on company letterhead with employment start date | |
| Change in worksite | Employer documentation on company letterhead showing change and impact on eligibility | |
| Leave of absence | Employer documentation on company letterhead stating employee has begun or returned from leave | |
| Place of Residence | Permanent change in residence of employee, spouse, or dependent that affects eligibility | Employer documentation on company letterhead on how residence change affects employee (ie availability of different health plans). |
QLE Effective Date
When the change goes into effect depends on your employer's group roles. Some employers make the coverage retroactively available from the date of the qualifying event. For many, coverage is effective as of the 1st of the month after the qualifying event.
However, there is one exception. For the birth of a child, coverage is always available as of the birth date.
