Qualifying Life Events (QLE)

Qualifying Life Events for Health Insurance

Qualifying Life Events (QLE) is a big life-changing situation for individuals or their families, whether planned or unplanned that affects an individual’s health plans or needs. These events have a direct bearing on their health insurance.

A Qualifying Life Events (QLE) may allow qualified individuals to be qualified for Special Enrollment. It allows them to make plan changes or enroll for Health Insurance immediately and outside of open enrollment dates (annual enrollment dates).

Generally, the Special Enrollment Period(SEP) will only last for 60 days before or after the qualifying event takes place. Please, ensure any enrollment fees or premiums due are paid during the same period.

It’s worth taking note that it doesn’t matter when enrollment changes are made, coverage will start on the date of the QLE.

QLEs are classified into four categories:

1. Loss of health coverage
2. Changes in household
3. Changes in residence
4. Other qualifying events

Life Qualifying Events

Qualifying Life Events (QLE) and their examples include (and are not necessarily limited to):

Loss of health coverage

• A child becoming an adult (above 26 years).
• Losing employment-based covers, COBRA, or a student plan
• Losing eligibility for Medicare, Medicaid, or the CHIPs

Changes in household

• Getting married, separating, Divorce, spousal abandonment, or Annulment
• Birth, Adoption, or receipt of a foster child.
• Death in the family or someone who shares the Health Insurance Plan
• Losing existing health insurance for another reason(except nonpayment of premiums)

Changes in residence

• Relocation to a new area (county or zip code)
• Students moving to or from college
• When into or from a shelter or transitional housing
• Moving into or out of the U.S. territory(s)

Other Qualifying Events

• Income changes affecting eligibility for Medicaid coverage
• When already in an ACA plan, then become eligible for tax credits that lower premiums
• New membership to a Federally recognized tribe or status as an Alaska Native Claims Settlement Act (ANCSA) Corporation shareholder.
• Becoming eligible for Marketplace coverage(Becoming a U.S. Citizen)
• AmeriCorps VISTA members(beginning or ending service)
• Release from incarceration
• Turning 65 years old

Exceptional Circumstance (also called Special Circumstance) may also qualify individuals for a Special Enrollment Period;

• New employment may trigger a special enrollment period for employment-based coverage. This usually activates a dis-enrollment period for another cover out there.
• Special Enrollment Periods (SEPs) may also be available for other qualifying reasons like natural disasters or pandemics.

Qualifying Life Events IRS

Health Insurance Plan elections cannot be amended for the remainder of the plan year unless you experience a life-changing event.

Any change is not retroactive except where it’s allowable under Health Insurance Portability and Accountability Act (HIPAA) or other applicable laws or policies.

In a nutshell, once an election is made, amendments are only allowed when there is a qualifying event, else wait till the next Annual Enrollment period, whichever is sooner.

Bottom Line

In any QLE situation, changes need to make to your health coverage plan within a specific time frame of the QLE.

• Ensure these changes are effected either 30 or 60 days after the QLE
• Missing a deadline could easily mean waiting until the next open enrollment, which sometimes could be as long as a year

Carriers will always ask for proof of a QLE taking place. A marriage certificate, birth certificate, or any other documentation should be provided for this.

If you are between enrollment periods and haven’t experienced a QLE, enroll in short-term insurance to bridge the gap. This ensures that you will be covered at any point.