What is a Qualifying Life Event?
While open enrollment happens only once per year within a specified window, qualifying life events can take place for employees at any point in the calendar year. Discover all you need to know about qualifying life events, including what they are, when they take place, and how you can stay on top of benefits administration, no matter the time of the year.
What is a Qualifying Life Event?
A qualifying life event is a change to an individual’s circumstances that allows them to make adjustments to their benefits outside of their annual enrollment period.
Typically, employees are eligible to make adjustments only during the company’s open enrollment period, often taking place towards the end of the year. If you or an employee experiences a qualifying life event, it is likely that you will be eligible for a special enrollment period.
Four Different Types of Qualifying Life Events
According to the federal government, there are four primary types of qualifying events:
Loss of health coverage: This can include job-based coverage, individual coverage, or student health plans. Typically these events occur when a person is laid off or fired, their employer ceases operations, a person leaves or graduates college, or when a person loses coverage through a parent’s plan after turning 26. Other instances include losing eligibility for Medicare, Medicaid, or CHIP.
Changes in household: Gaining or becoming a dependent are both considered qualifying life events. Examples include getting married or divorced, having a baby or adopting a child, as well as having a death in the family.
Changes in residence: This would include when someone moves to a different ZIP code or county when a student moves to or from the place where they attend school, a seasonal worker moves to or from the place they both live and work, or someone moves to or from a shelter or other transitional housing.
Other qualifying events: Other types of events can include changes in a person’s income that impact the coverage they qualify for, gaining membership in a federally recognized tribe, or gaining status under the Alaska Native Claims Settlement Act (ANCSA), becoming a U.S. citizen, leaving incarceration, and when AmeriCorps members begin or end their service.
How Can I Stay Organized?
It’s imperative that employers have the appropriate processes in place to correctly administer benefits when an employee has a qualifying life event.
Utilizing a human resources information system (HRIS) is key to staying organized. A robust platform like BerniePortal empowers HR managers to keep track of appropriate employment documents—such as W-4s, I-9s, and other new hire information—and helps them to remain compliant with legal standards and regulations.
Beyond compliance, an HRIS empowers current employees to make their own changes without added assistance from HR managers. By presenting benefits options on a single, intuitive system, you streamline and simplify the process for employees and management alike. This is more convenient for each person involved and will allow you more time to focus on retention and recruitment strategies by shaping the overall culture of your team.
What Kind of Documents are Needed for A Qualifying Life Event?
Your specific qualifying event will determine the exact documentation that is required. Here is a breakdown of the documentation required for each type of life event:
Birth, adoption, or legal guardianship requires a birth certificate (or an application for such), adoption record, legal guardianship documentation, or any court order including child support.
Marriage will require a marriage license.
Loss of job-based coverage will require that you submit a letter from your employer with the reason for the loss of coverage. This can include a termination letter from your employer, a termination letter from your former health plan, or COBRA documentation providing the correct length of coverage.
Divorce will require you to file divorce or annulment documentation along with proof that you were covered under a qualified health plan within the last 60 days.
Death requires a death certification to be provided as well as evidence of coverage within the previous 60 days.
When you lose coverage by turning 26, you must provide documentation proving you held qualified health coverage within the previous 60 days.
When you gain U.S. citizenship, you will be required to provide your naturalization certificate or a certification of citizenship.
How Long Do You Have for a Qualifying Life Event?
Once you experience a qualifying event, you will have 60 days to either select or change your plan. Though that number can vary between 30 and 60 days before or after the event takes place, depending upon your qualifying event as well as your health plan.
Should you change plans due to a qualifying event, the plan will typically begin on the first of the following month so long as you apply prior to the 15th of the month. Though as of 2022, Healthcare.gov will no longer enforce this deadline.
You can stay informed, educated, and up-to-date with important HR topics using BerniePortal’s comprehensive resources:
- BerniePortal Blog—a one-stop-shop for HR industry news
- HR Glossary—featuring the most common HR terms, acronyms, and compliance
- HR Guides—essential pillars, covering an extensive list of comprehensive HR topics
- BernieU—free online HR courses, approved for SHRM and HRCI recertification credit
- HR Party of One—our popular YouTube series and podcast, covering emerging HR trends and enduring HR topics
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