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Qualifying Life Events (QLE) for Special Enrollments
Qualifying Life Events (QLE) for Special Enrollments

Employees can trigger Special Enrollment Periods to enroll in an ICHRA Health Care Plan by having a Qualifying Life Event (QLE)

Updated over a week ago

Every year an Open Enrollment for health insurance benefits generally runs from November 1st to December 15th. Outside of Open Enrollment, employees need a Qualifying Life Event to trigger a Special Enrollment Period to purchase a plan.

Qualifying Life Events are situations that cause a change in your life that has an effect on your health insurance options or requirements. If you have a life event mid-year and you need to make changes to your health care plan let your employer know. Your employer can trigger a Special Enrollment Period if you have a Qualifying Life Event.


Examples of qualifying life events

Loss of health care coverage

  • Losing health insurance for any reason except not paying premiums

  • Losing eligibility (Medicaid, Medicare, or a Children's Health Insurance Program)

  • Turning 26 and losing coverage through a parent's plan

  • Loss of job-based coverage (quit or fired)

Changes in household

  • Marriage, divorce, or legal separation

  • Pregnancy, adoption of a child, or any addition of dependents

  • Losing coverage due to a death in the family

Changes in residence

  • Moving to a different coverage area (state, county, or zip code)

  • Student moving schools

  • Workers moving to and from the place they live and work

Other qualifying events

  • Becoming a U.S. citizen

  • Released from incarceration

  • Your spouse retires, which forces you to lose coverage

  • Your spouse changes jobs

After applying for your health care plan during a Special Enrollment Period, you may need to provide documentation of your Qualifying Life Event so the insurance provider can confirm that you meet Special Enrollment Period requirements.

Once you have selected a health insurance plan, you will have 30 days to send documents to the insurance provider that detail your Qualifying Life Event. It is important for you to know that your policy will begin when you have picked a plan, but you will not be able to use the insurance until your eligibility has been confirmed and the initial premium has been paid. If you are not approved for a Special Enrollment Period, then the policy will be canceled or you will need to provide additional documents supporting the Qualifying Life Event.

In closing, if you do not qualify for a Special Enrollment Period, you will have to wait until the next Open Enrollment Period to get health insurance or to change your existing health care plan.

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