Open enrollment is the standard time for employees to change their health coverage — but it’s not the only time. Certain life events allow employees to make mid-year changes to their benefits outside of the regular enrollment window.
What Is a Qualifying Life Event (QLE)?
A Qualifying Life Event (also called a Special Enrollment Period trigger) is a significant change in an employee’s life or coverage situation that allows them to enroll in, change, or drop coverage outside of open enrollment. Employees typically have 30 days from the event to request the change.
Common Qualifying Life Events
- Marriage or divorce — employees can add a spouse or drop a former spouse
- Birth or adoption of a child — employees can add a new dependent
- Loss of other coverage — employee or dependent loses coverage from another source (spouse’s plan, Medicaid, etc.)
- Gaining new coverage eligibility — employee becomes eligible for another plan (e.g., spouse gets a new job with benefits)
- Death of a dependent — allows removal of deceased from coverage
- Change in employment status — going from full-time to part-time, or vice versa
- Moving to a new area — if current network doesn’t cover the new location
What Employers Need to Know
As an employer, you need to notify employees of their QLE rights and have a process for handling mid-year enrollment changes. When an employee reports a QLE, you typically have a short window to submit the change to your carrier.
Missing a QLE window can leave an employee without needed coverage — or stuck paying for coverage they no longer need. Make sure your employees know to report life events promptly.
Garden State Benefits helps employers manage QLE changes year-round — not just during open enrollment. Reach out if you have a mid-year enrollment situation.