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Benefits A-Z: Qualifying Life Event

Typically, you can only change your insurance benefits during your open enrollment period. In most cases, if you need to make a change in your policy, you are out of luck until your next enrollment period. However, some major life events give you the power to add or remove coverage. These are called Qualified Life Events or QLE. It is estimated that around 9 million Americans each year may have a QLE giving them the power to make changes and not know it.

What is a Qualifying Life Event?

Also known as a “qualifying event”, these events are major life changes that may affect your insurance needs or qualifications for existing insurance. They may make you eligible for special enrollment period for the ACA marketplace, your employer sponsored plans, or even some private insurance plans. A special enrollment period (SEP) normally lasts 30 days from the date of your qualifying event.

Examples of QLEs

Major life events that are considered QLEs include:

  • Change in job status: If you use your employer sponsored insurance and lose your job, then you can use this event to either get on your spouse’s insurance, or enroll in a new plan on the ACA marketplace. Likewise, if you gain insurance through a new employer, then you can drop existing coverage on COBRA or your spouse’s plan.
  • Change in family status: Getting married, divorced, death of a spouse or dependent, having a child, or gaining a court ordered dependent can all affect your enrollment status. Some of these events only let you make changes to existing plans such as adding or dropping a spouse or dependent.
  • Loss or gain of coverage: Typically the loss or gain of eligibility for federal programs like Medicaid is considered a qualifying event. Another example in this category is if you are turning 26 and are about to lose coverage under your parents’ plan.

These life changes are NOT life events and thus, do not allow you to make changes to your insurance plans:

  • Affordability: Realizing you cannot afford your insurance is not a QLE. Because of this, it is very important to only choose a plan that you will be able to afford for the year, assuming you have no major changes in employment. If you can no longer afford your insurance due to loss of or change in job status, then you may have a qualifying event as described above.
  • Cancellation of insurance due to non-payment: having your insurance involuntarily canceled by the insurance company due to non-payment of premiums does not qualify you for a special enrollment period.
  • Voluntarily dropping current insurance: Most private insurance plans will allow you to drop coverage for any reason. However gaining new coverage may be a challenge because this is not a qualifying event.

While these lists are a good set of guidelines on what is and is not a qualifying life event, they are not the only ways you may qualify for new coverage. There are a number of special circumstances that are not listed here which may qualify you for a special enrollment period. These are determined on a case by case basis and a list of examples can be found here. If you think you may be experiencing a qualifying event, contact your benefit administrator, plan documents, or insurance carrier to discuss your options.

If you are still confused about qualifying events or have questions about any insurance products, contact one of our benefit consultants to get some guidance.