Qualifying Life Event

A Qualifying Life Event (QLE) is a key life change—such as marriage, birth, or losing coverage—that permits you to update your health insurance.

What is a qualifying life event (QLE)?

A qualifying life event for insurance is a change in life situation that makes a person eligible to enroll in health insurance outside of the annual Open Enrollment or New Hire Enrollment Window.

Marriage, divorce, and parenthood are all common examples of major events that affect a person’s health insurance needs. Under these circumstances, an individual qualifies to immediately buy or make changes to a health plan.

Depending on your plan, a qualifying life event gives you 30 days (sometimes 60 days) to make plan changes or sign up for new coverage.

If any of your employees have recently gone through one of the following qualifying life events, they are eligible to adjust their current benefits plan.

QLE

Loss of Health Coverage

  • Loss of existing health coverage, including coverage through employment, individual plans, or student health plans
  • Loss of eligibility for programs like Medicare, Medicaid, or the Children’s Health Insurance Program (CHIP)
  • Turning 26 and losing coverage under a parent’s health plan, which qualifies as a loss of coverage QLE. The employee’s new coverage can be retroactively applied to the termination date of the previous plan.
QLE

Change in Employment Status

A change in employment can also trigger a QLE, such as:

  • Being hired (note that new hires may be subject to a waiting period)
  • Quitting a job or being laid off
  • Transitioning from part-time to full-time work (or vice versa)

This type of event can result in a retroactive application of new coverage, based on when the previous coverage ended. These changes apply to both employees and their dependents

QLE

Change in Marital Status

  • Getting married allows employees to add their spouse to their insurance within 30 days of the marriage date.
  • Divorce would require removing a spouse from the policy or obtaining separate coverage. Employees must act within 30 days after the divorce is finalized.
QLE

Changes in Household

  • Marriage or divorce
  • Having a baby or adopting a child enables the employee to add their child to their plan within 30 days of the birth or adoption.
  • Loss of a family member may also qualify.
QLE

Other Qualifying Life Events

  • Relocation to the U.S.: Moving to the U.S. with a passport stamp dated within the last 30 days allows employees and dependents to join a health plan.
  • Spousal open enrollment: If an employee’s spouse is undergoing open enrollment and opts into or out of their own coverage, it qualifies as a QLE.

Is quitting a job a qualifying event for health insurance coverage?

Yes. If an employee quits, it triggers a special enrollment period that allows them to enroll in coverage through their state’s health insurance marketplace.

Is a spouse losing their job a qualifying life event?

Yes. If an employee’s spouse loses their job and health coverage, it qualifies as a QLE, and the employee can add their spouse within 31 days of the event.

How long do you have to act on a qualifying life event?

Typically, employees have 30 days from the date of the QLE to make changes to their benefits plan. For example, if you turned 26 on April 25th, that date starts your 30-day window to update your benefits. Similarly, if you were married on May 1st, the same timeline applies.

What is a qualifying life event (QLE)?

These proof of documents must be dated within 30 days of the QLE occurrence

If,
Submit one of these documents

You got married

Fully-executed Marriage Certificate

You got divorced

Divorce Decree

Legal Separation Papers

You gave birth or adopted a child

Official Birth Certificate (if received within 30 days of the birth)

Notice of Legal Adoption (Official fully-executed legal document required)

Birth Certificate issued by hospital

You lost eligibility in other benefits

Coverage termination notice from a government agency

HIPPA Certificate of Credible Coverage

Signed letter (on company Letter Head) from the dependent’s former employer, confirming their coverage termination and the date coverage ended.

Proof of offer of COBRA coverage

You gained eligibility in other benefits

Offer letter from your spouse or domestic partner’s new employer showing your benefits eligibility

Payroll stub from your spouse or domestic partner showing benefit deductions have begun

Your dependent passed away

Certified and legal Death

Certificate for your dependent

You or your dependent reached the maximum age of 26

No documentation required

Family Arrival in the USA

I94 with stamped date of entry proof.

USCIS letter showing admission to USA.