What Are Qualifying Events?

What Are Qualifying Events?

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Qualifying Events: When Can Employees Make Changes to Benefits Enrollment?

“Qualifying life events” are changes in personal circumstances that allow an employee to alter their insurance elections outside of the usual open enrollment period. Qualifying events can change the amount of insurance an employee needs or the number of people that are covered under the policy. Most of the time, an employee has a special enrollment period for 30 days from the date of the qualifying event to make changes to their coverage.

The most frequently cited qualifying life events involve either a loss of health coverage or changes in household, but there are other events that may also trigger a special enrollment period.

What Are Eligible Qualifying Events?

The most common qualifying life events employees experience include:

  • Marriage or divorce
  • Birth or adoption of a child
  • Death of family member that shares your insurance coverage
  • Involuntary loss of coverage, for example, if a spouse loses their job and coverage
  • Increase or decrease in hours worked, resulting in change in eligibility status for coverage
  • Turning 26 and losing coverage under a parent’s plan
  • Turning 65 and becoming eligible for Medicare

Proof Is Required

Most insurers will require supporting documentation of the qualifying life event in order to approve an enrollment change outside of the regular election period. Requirements vary according to the event type and include items such as copies of a marriage or birth certificate, divorce papers, proof of loss of other coverage, or a death certificate.

Can an Employee Drop Coverage Without a Qualifying Event?

An employee is only permitted to voluntarily drop their group coverage if the company is not deducting the employee’s contribution to their medical coverage on a pre-tax basis. Since most employers, by far, take advantage of Internal Revenue Code Section 125, this is seldom an option available to employees.

Learn More About Qualifying Events

Understanding qualifying events is vital to correctly administering your company’s group benefits! Contact benefEx today to discuss how qualifying life events and other benefit nuances influence your company’s overall benefits strategy.