You’ve probably heard the term qualifying life event before, mostly likely as it related to insurance. But do you know what it means? Qualifying events are life-changing events that allow you to alter your benefits elections outside of open enrollment. Benefits that provide a tax benefit (premium deductions taken out pre-tax) must follow certain rules outlined in Section 125 of the Internal Revenue Code. When a participant can add, remove or change such benefits is one of these rules.
While each plan may have some slight differences (review benefits plan documents to confirm) the most common changes you can make due to qualifying life events are listed below.
You can add new coverage when:
- You lose other group insurance coverage.
You can add a new dependent when:
- A child is added to your family though birth or adoption,
- A spouse (and/or dependent child) is added to your family through marriage, or
- A spouse or dependent child loses other group insurance coverage.
You can remove a dependent from your coverage when:
- A dependent child reaches age 26 and is no longer eligible,
- Divorce (spouse and stepchildren),
- Loss of life (spouse or dependent child), or
- Spouse or dependent child obtains other group insurance coverage.
You can cancel all coverage and drop all dependents when:
- You are no longer eligible for the health plan because you are no longer working the required number of hours per week, or
- You obtain other group insurance coverage.
Once any of these qualifying life events happens, you typically have 30-60 days to change your insurance plan or enroll in a new one. For your plan to change, you will also need to provide supporting documents that prove the qualifying event. For example, if you were recently married and want to add your spouse to your plan, you would need to provide your marriage certificate as evidence of the qualifying life event. Again, check the plan details for your specific policies to be sure. If a qualifying life event happens and you don’t make a change to your plan before the deadline, you will have to wait until the next open enrollment period to make changes to your plan.
Managing the intricacies of benefits can get complicated fast. The Helpside Client Success and Benefits Teams are available to help employees navigate the intricacies of their benefits plans in both English and Spanish. Reach out to Helpside at firstname.lastname@example.org.