What is a Qualifying Life Event?

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: 

  1. Supporting documents (see "Required Documents" below), and 
  2. 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).

4 Basic Types of QLEs

The most common examples include:

  1. 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
  2. Changes in household

    • Getting married or divorced
    • Having a baby or adopting a child
    • Death in the family
  3. Changes in residence

    • 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
  4. 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 CategoryType of ChangeSupporting Documents
Legal Marital StatusMarriageMarriage certificate

Divorce or annulmentDivorce decree/court ruling for annulment

Legal separationCourt order of legal separation

Death of spouseDeath certificate
Number of DependentsBirthBirth certificate

DeathDeath certificate

Adoption/placement for adoptionCourt 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 SpouseLoss of employmentTermination documents on company letterhead, COBRA letter, or unemployment application

Start of employmentEmployer documentation on company letterhead with employment start date

Change in worksiteEmployer documentation on company letterhead showing change and impact on eligibility

Leave of absenceEmployer documentation on company letterhead stating employee has started or returned from leave
Gain/Lose Eligibility for Other Group Coverage (HIPAA special enrollment)Group health planDocumentation from plan or carrier regarding change in eligibility with effective date
Employment status of Employee or SpouseLoss of employmentTermination documents on company letterhead, COBRA letter, or unemployment application

Start of employmentEmployer documentation on company letterhead with employment start date

Change in worksiteEmployer documentation on company letterhead showing change and impact on eligibility

Leave of absenceEmployer documentation on company letterhead stating employee has begun or returned from leave
Place of ResidencePermanent change in residence of employee, spouse, or dependent that affects eligibilityEmployer 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.

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