A qualifying life event (QLE) refers to a significant personal or family change that impacts a person’s health insurance needs or eligibility. Recognized by the IRS, these events trigger a Special Enrollment Period (SEP), allowing individuals to make changes to their health insurance coverage outside of the regular open enrollment window.
How Qualifying Life Events Work
Under the Health Insurance Portability and Accountability Act (HIPAA) and Section 125 of the Internal Revenue Code, individuals who experience a QLE are legally entitled to adjust or enroll in health insurance plans outside of the standard enrollment period. This provision ensures employees aren’t locked into a plan that no longer meets their needs due to major life changes.
For companies that offer health benefits, like those supported by Beyond, open enrollment generally happens once a year, often lasting around 60 days between November and January. During this time, employees can evaluate their healthcare needs and choose appropriate coverage for the year ahead.
However, if an unexpected event occurs during the year that significantly alters a person’s insurance requirements, they may qualify for a Special Enrollment Period. Employers must provide this opportunity to eligible employees when a QLE takes place.
Examples of Qualifying Life Events
While exact definitions can vary slightly between states and plans, Healthcare.gov outlines several common situations that qualify as QLEs, such as:
- Change in household status (e.g., marriage, divorce, birth or adoption of a child, or the death of a dependent)
- Loss of existing health coverage, including employer-sponsored plans, COBRA, or government programs like Medicaid, CHIP, or Medicare (as long as it’s not due to failure to pay premiums)
- Relocation that affects access to coverage (for example, moving to a new ZIP code or state)
- Changes in eligibility for health insurance programs (e.g., turning 26 and aging out of a parent’s plan, or changes in employment status)
These events open a time-limited window, usually 30 to 60 days, during which employees can enroll in or modify their health insurance coverage.
Why QLEs Matter
QLEs exist to ensure individuals and families maintain appropriate health coverage when their circumstances change unexpectedly. Without them, someone facing a major life shift, like the birth of a child or a job change, would have to wait months for the next open enrollment period, potentially going without adequate insurance during a critical time.
By offering a Special Enrollment Period, companies like those partnered with Beyond help ensure compliance with federal regulations while also supporting their employees through transitional life events.