Qualifying life events or QLEs: these are special circumstances, often family status changes, that can occur outside of regular eligibility periods which allow you to make changes to your benefits.
Usually, these changes can only occur when you’re enrolling as a new hire or making benefit elections at open enrollment, but QLEs allow for adjusting your health coverages when certain situations call for it as a kind of special enrollment period.
The most common QLEs are:
- Dependent turning 26/aging off a parent’s plan
- Marriage or divorce/separation
- Childbirth/adoption
- Gaining/losing other coverage
- Changes with Medicare/Medicaid
- Guardianship changes, including custody
- Change in eligibility (move from part-time to full-time or class change) – note: this kind of change can be subject to waiting period rules like new hires
Some QLEs are anticipated, and it can be beneficial to notify your manager or company’s HR contact ahead of time to make sure you have everything you need to make changes. If an event is not expected, it is just as important to report and submit these occurrences as soon as possible. QLEs must be reported within 31 days of the event date and exceptions to this timeframe are generally not allowed by insurance.
When you experience one of these events, insurance carriers may require proof of its occurrence, including but not limited to the following:
- Loss/gain of coverage letter
- Marriage certificate
- Court/legal documents
Communicating with your employer in a timely manner and preparing relevant documentation such as enrollment or waiver forms and what’s listed above, etc. can help to ensure there are no delays in processing your QLE.
If you have any questions regarding qualifying life events, please reach out to your Schauer Group representative.
