Qualifying Life Event


Qualifying Life Event

A qualifying life event (QLE) is an event deemed acceptable by the IRS that may allow participants in cafeteria plans to change their benefit elections.

You may change your benefit elections during the annual Open Enrollment period or during the year if you experience a Qualifying Life Event. A Life Event change permits employees to make certain mid-year benefit changes consistent with the qualifying event. You must consult your Benefits Administrator within 31 days from the date of the event to make changes.





Qualifying Life Events:

1. Special Enrollment Rights: An event described in the Special Enrollment provisions as shown in the group policy/plan;
2. Entitlement to or loss of eligibility for Medicare or Medicaid: The employee or the employee's dependent becomes entitled to or loses eligibility for Medicare (Part A or Part B) or Medicaid.
3. Special Requirements relating to the Family and Medical Leave Act (FMLA): An employee takes leave under FMLA, in which case the employee may revoke an existing election of health plan coverage and make such other election for the remaining portion of the period of coverage as may be provided for under FMLA.
4. Significant cost or coverage changes: Cost of coverage changes significantly.
5. A judgment, decree or order: Resulting from a divorce, legal separation, annulment, or change in legal custody (including a qualified child support order) that requires health coverage for an employee's dependent child or for a foster child who is a dependent of the employee.
6. Changes in status events, which include the following:
a) Legal marital status: Change in the employee's legal marital status, including marriage, death of spouse, divorce, legal separation and annulment;
b) Number of dependents: Change in the employee's number of dependents, including birth, death, adoption and placement for adoption.
c) Employment status: Change in the employment status of the employee or the employee's dependent, including termination or commencement of employment, a strike or lockout, a commencement of or return from an unpaid leave of absence or a change in worksite. This also includes a change in the employee's or the employee's dependent's employment status resulting in the individual becoming or ceasing to be eligible under the group policy/plan;
d) Eligible dependent status: Change in the eligibility of a dependent due to reaching a limiting age, change in student status or any similar circumstance; and
e) Residence: Change in the place of residence of the employee or the employee's dependent provided that the change in place of residence affects the eligibility for the employee or the employee's dependent's coverage under the group policy/plan
Consistency Rule: In all cases, any election change as a result of any change in status must be on account of and correspond with a change in status that affects eligibility for coverage under the plan. For example, if the change in status is the employee's divorce, the death of a spouse, an employee's election to cancel health coverage will apply only to the spouse involved