Life is unpredictable, and even the most carefully laid out plans can be disrupted by unexpected events. Whether it’s a marriage, a divorce, a birth, or a job loss, major life events can significantly impact your finances and insurance coverage. These events are known as qualifying life events (QLE). Understanding how they can affect your health, life, and other insurance policies is crucial for protecting your family and finances. In this blog, we’ll explore the ins and outs of QLEs and provide you with the knowledge you need to make informed decisions about your insurance coverage.
What Are QLEs?
A qualifying life event is an event that triggers a special enrollment period for individuals or families to purchase health insurance outside of the regular annual Affordable Care Act (ACA) open enrollment period. Qualifying life events typically include, but are not limited to, the following:
- Having a child
- Adopting a child
- Becoming newly married or divorced
- Experiencing a death of the insurer in the family
- Losing health insurance coverage due to a job loss
- Losing eligibility for Medicare, Medicaid, or Children's Health Insurance Program (CHIP)
- Turning 26 years old and losing coverage from your parent's health insurance plan
- Moving to a different county or zip code changes your health plan area
How Does It Work?
To take advantage of a qualifying life event, you typically have a limited time frame to make changes to your health insurance plan. This period varies depending on the event and the insurance provider; however, it usually lasts around 60 days. To make changes, you must provide documentation of the QLE to your insurance provider. The documentation you must provide varies on the life event but could include the following:
- Birth certificates
- Adoption records
- Marriage license
- Divorce papers
- Death certificates
- Rental agreements/mortgages
- Termination documents
If you experience a qualifying life event, signing up right away is important. Check your plan materials, contact your employer, or call the phone number on your member ID card. In most instances, you’ll need to change your health insurance plan within a specific time frame of the QLE. Changes can most often be made within either 30 or 60 days of the qualifying life event.
Amie Hatlovic, GMS' Manager of Benefits Account Managers, expressed, "Guidelines set forth by the ACA state that job-based group plans must provide at least 30 days for a special enrollment period (SEP). That 30-day starts with the exact date of the qualifying life event. A partnership with GMS provides your employees with access to GMS Connect. In GMS Connect, the employee self-service portal is equipped with a feature to add a life event that will launch a notification to the Benefits Account Specialist at GMS. Supporting documentation can be uploaded during this period. The assigned benefits team is always available for assistance."
If you miss the deadline, you'll have to wait until the next open enrollment period, which could be as long as a year. It's essential your employees understand how long they have to sign up for a qualifying life event so they can enroll in the benefits suited to their needs.
Don’t Face Life’s Challenges Alone – Let A PEO Be Your Partner
In times of change and uncertainty, having a trusted partner by your side can make all the difference. When it comes to navigating the complexities of qualifying life events and their impact on your employee benefits, a professional employer organization (PEO) such as GMS can be the partner you’re looking for. We provide clear communication to employees about their options and deadlines for making changes to their health insurance. In addition, we help you evaluate the available health insurance plans and recommend options that are best suited to the employee’s needs and budget. Finally, we manage the ongoing administration of the health insurance plans, such as processing claims, managing enrollment, and answering employee questions. Don’t face these challenges alone. Contact us today so we can help you through life’s ups and downs.