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Qualifying Life Events Create Opportunities

If you’re facing big changes in your life, you should consider whether they also warrant changes to your health benefits.
Typically, you can’t sign up for or make changes to your employer-sponsored health benefits until the annual open enrollment season.
However, if you’ve experienced what’s known as a Qualifying Life Event – major changes in your life – you might have a chance to make changes at other times 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. These include things such as:

  • Involuntary loss of health coverage, such as a spouse losing benefits that cover you or a plan being discontinued.
  • 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.

If you have experienced a Qualifying Life Event, you likely are 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 million 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 what’s going on. 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 choose the best benefits plan for your new situation.

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