Open enrollment only comes one time each year, which means it’s the only time each year that you can make a change to your insurance policy including adding, adjusting, or removing coverage. However, there are a few major life events that can bypass this rule. Such an event is referred to as a Qualified Life Event, or a QLE. QLEs are more common than you may think, and it’s important to be aware if your situation qualifies as an QLE so that you are able to adjust your policies accordingly.
WHAT IS A QUALIFIED LIFE EVENT?
A simple definition of a QLE is a major life change that can affect your insurance needs or qualifications for existing insurance. These events can make you eligible for the Special Enrollment Period, which would allow you to enroll in benefits outside of the typical Open Enrollment Period. A Special Enrollment Period, or SEP, typically lasts 30 days from the date of your qualifying event. Additionally, the QLE could make you eligible for your employer sponsored plans and even some private insurance plans.
WHAT IS CONSIDERED A QLE?
- Change in job status: If you are on your employer’s sponsored insurance plan 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. Similarly, if you get on a new plan through a new employer, you can drop existing coverage through COBRA or your spouse’s plan.
- Change in family status: Getting married, divorced, the death of a spouse or dependent, having a child, or gaining a court ordered dependent can affect your enrollment status. However, some of these events will only allow you to make changes to an existing plan such as adding or dropping a spouse or dependent.
- Loss or gain of coverage: Usually, the loss or gain of eligibility for federal programs like Medicaid is considered a qualifying event. Additionally, if you are turning 26 you will no longer be covered under your parents’ plan, which would then qualify you as losing coverage.
The following life changes are NOT life events and thus, do not allow you to make changes to your insurance plans:
- Unaffordability: No longer being able to afford your insurance does not constitute as a QLE. With this in mind, it is essential that you choose plan that you know you will be able to afford for the year, assuming you have no major changes in employment. However, if you can no longer afford your insurance due to a sudden change in job status, you may have a qualifying event.
- Cancellation of insurance due to non-payment: If your insurance were involuntarily canceled by the insurance company due to a nonpayment of premiums, you would not qualify for a special enrollment payment.
- Voluntarily dropping current insurance: If you drop coverage with your current insurance plan voluntarily, you will have to wait until the next open enrollment period to gain new coverage.
While these are the most common events that could qualify you for a special enrollment period, there are still a number of other special circumstances that may qualify you for a SEP. 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.