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Qualifying Life Events

We’re all accustomed to thinking that the only time you can sign up for or make changes to health benefits is during the annual Open Enrollment season. Typically, that is the case; however, what’s known as a Qualifying Life Event can open the door to changes any time of the year. Commonly referred to simply as a QLE, a Qualifying Life Event is exactly what it sounds like: a life event important enough to qualify you to make benefits changes.

QLEs might differ slightly from one benefits provider to another, but generally they include life events that substantially change your benefits status. Typically, these include:

  • A change in eligibility (turning 26 and losing parental coverage, for example, or increasing or decreasing your income)
  • A change in employment status, such as getting a new job or altering your employment terms (reducing your hours to part-time, for example)
  • A change in family status as a result of a marriage, divorce, separation, adding a dependent, or losing a family member
  • A long-distance relocation
  • Mistakes in your plan enrollment

If you have experienced a Qualifying Life Event, you’re likely eligible for a Special Enrollment Period (SEP), a window of time when you can make changes to your benefits enrollment.

This apparently happens more often than we think: A University of Minnesota study suggests that as many as 8 to 10 million Americans
might be eligible for special enrollment periods each year, and an Urban Institute study estimated that fewer than 15 percent of consumers who are eligible for SEPs actually take advantage of the opportunity.

So, what should you do if you experience a QLE? First, decide whether you need to make changes to your benefits. Then, contact your HR representative or your benefits provider and tell them the situation. You might be asked to offer proof of the QLE, but usually notifying them and filling out paperwork is all it takes to open up a Special Enrollment Period. Then you can assess your options and chose the best benefits plan for your new situation.

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