What Are “Qualifying Life Events” for Health Insurance and Why Do They Matter?
February 05, 2018
You may have heard the terms “qualifying life event” or “QLE” in regard to health insurance policies. As with many aspects of understanding the ins and outs of insurance, this is a concept that’s important to understand, even if you’re not immediately experiencing or anticipating an event of this type.
The bottom line is that qualifying events can provide you with an opportunity to make changes to your coverage based on changing situations in your life. Otherwise, the specific coverage you have will generally be in force until the next open enrollment period with your employee or insurance provider. And that could be as much as a year, if that period has just passed.
Life changes like these can also have an impact on your COBRA coverage after you leave an employer, as well as your options under a plan obtained through an exchange under the Affordable Care Act.
These event-driven exceptions are designed to help you adapt your coverage to significant, sometimes life-changing, perhaps unexpected occurrences before the official plan year is done.
Here are some examples of key qualifying events:
- Loss of your health insurance, except by not having paid your premiums
- Change in marital status, including divorce and in some cases civil unions and domestic partnerships depending on the policy and/or the state
- Birth of a child and adoption, as well as becoming a legal guardian or taking in a foster child
- Reaching the age of 26 and thereby aging out of a parent’s insurance, or having a dependent who ages out of your coverage
- Turning 65 which makes you eligible for Medicare
- A shift in employment status like going from full-time to part-time (or the reverse)
- Moving to different state, if the new state has an impact on your access to provider network access, which is particularly relevant for HMO or DMO plans
- Your spouse loses his or her coverage
- Earning citizenship in the U.S.
You should be aware that proof will required of an event like this, which is reasonable. So be prepared to know what kinds of documentation may be required, where to get it and how long it’s likely to take.
If you think you have or are about to experience one of these qualifying events, you must pursue any changes to your policy within a specific timeframe. So don’t wait around and get a bad surprise when you finally inform your employer or carrier. Federal law stipulates that you must provide notice within 30 says. But some carriers and marketplaces may offer up to 60 days. There may also be what are called special enrollment periods to be aware of.
Make sure you know where you stand. Be prepared. And keep your insurance coverage up to date.