A QLE is a significant life change that may impact an individual's health insurance needs. These events include, but are not limited to, marriage, birth or adoption, divorce, loss of other health coverage, and changes in residence.
When employees experience a QLE, they may be eligible to make changes to their health insurance coverage outside of the regular open enrollment period.
Effectively managing a QLE is not only a regulatory responsibility but also an opportunity for employers to demonstrate support for their employees during significant life changes. By establishing clear processes, maintaining open communication, and staying informed, employers can navigate a QLE with efficiency and empathy, contributing to a positive workplace experience for their teams.
Below are some recommended best practices to follow when an employee experiences a QLE:
Clear communication: Ensure that your employees are aware of the QLEs that may allow them to make changes to their health insurance coverage. Provide clear communication about the process, timelines, and required documentation.
Document verification: When employees submit documentation to support their QLE, carefully verify the authenticity of the documents. This may include marriage certificates, birth certificates, or other relevant proof depending on the nature of the life event.
Benefits administration: Promptly update benefits administration systems to reflect any changes resulting from QLEs. This includes adjusting health insurance coverage, updating beneficiary information, and making changes to other employee benefits.
Notification of changes: Communicate changes in benefits or coverage resulting from QLEs to the affected employees. Clearly outline any adjustments in premium amounts, payroll deductions, coverage start dates, or other relevant details.
Compliance with regulations: Stay informed about and ensure compliance with applicable regulations and laws related to QLEs. Regularly review and update policies to align with current legal requirements.
Employee assistance: Offer assistance and guidance to employees navigating the QLE process. Establish clear communication channels and provide access to resources that can help them understand their options.
Privacy and confidentiality: Maintain the privacy and confidentiality of employee information related to QLEs. Implement secure handling practices to protect sensitive personal data.
Record keeping: Keep accurate records of QLE-related transactions and communications. Organized record-keeping facilitates transparency, especially in case of audits or inquiries.
Stay informed: Stay informed about changes in healthcare and benefits regulations. Regularly update your knowledge to ensure that your company's policies align with current legal requirements.
There are a range of events that can qualify as a qualifying life event (QLE). The following are the most prevalent types of QLEs.
Loss of health insurance
Losing coverage through a parent’s insurance plan on your 26th birthday Losing coverage due to a job loss, COBRA, or a student plan Losing eligibility for Medicare, Medicaid, or CHIP Losing health insurance for any reason other than not paying premiumsChanges in your household
Getting married, separated, or divorcedAdding a child to your family, such as giving birth, adopting a child, or taking care of a foster child
Experiencing the death of a family member enrolled on your health insuranceChanges in your residence
Moving to a different county or ZIP code Students moving to attend school or back home from school Seasonal workers moving to a work location or back home from a work location Moving in or out of a shelter or transitional housingChanges to eligibility
A change in income affects Medicaid eligibility Becoming eligible for tax credits that lower premiums after enrolling in an ACA plan Becoming a member of a federally recognized tribe Becoming a U.S citizen For AmeriCorps VISTA members, beginning or ending service Being discharged from the military Being released from incarcerationQualifying Life Events (QLEs) often require documentation to support the changes made to health insurance coverage. Proper documentation is essential for verifying the occurrence of the event and ensuring accurate processing.
Ensuring you have the appropriate documentation is crucial for a smooth and efficient processing of your health insurance changes during a QLE. Always check with your health insurance provider for specific documentation requirements related to your circumstances.
Below are common types of QLEs and the corresponding documentation that may be needed:
Loss of health insurance