Qualifying Life Events

Changing Your Benefits Outside the Annual Enrollment Period

A qualifying life event is a change in your situation that may allow you to alter your benefit elections.

Benefit changes must correspond with your specific life event. For example: If you get married, you may add your spouse to the benefit plan, but you may not drop coverages you have already elected.

When you experience a qualifying life event, you must complete benefit changes within 30 days of the event. For example: If you have a baby on September 1, your newborn must be added to the plan no later than September 30.

If you have questions about qualifying life events or you need to make changes to your benefits, contact your employer's Human Resources Department or Employee Benefits Manager. If you're not sure who to contact, reach out to Benefit Innovations.

What is Considered a Qualifying Life Event?

Changes in Your Household

You get married
You get divorced
You have a baby
You adopt a child
Your spouse or child dies
You, your spouse, or your dependent experience a change in employment status
Your dependent becomes eligible according to the plan's eligibility rules
Your dependent no longer satisfies the plan's eligibility rules

Changes in Your Residence

You move to a new zip code or county which significantly affects your access to benefits
Your dependent child is a student moving to or from the place they attend school
You are a seasonal worker moving to or from the place you both live and work
You are moving to or from a shelter or other transitional housing

Changes in Your Income

Changes in your income that affect the coverage you qualify for
Reduction in your hours of service
You're taking approved FMLA leave
You are taking an employer-approved unpaid leave of absence
You, your spouse, or your dependent become eligible to enroll in Marketplace coverage

Changes in Your Coverage

You, your spouse, or your dependent lose health coverage elsewhere, including job-based, individual, and student plans
You, your spouse, or your dependent gain health coverage elsewhere, including job-based, individual, and student plans
There is a significant cost change for your benefits
There is a significant curtailment of coverage (this can be a complete loss of coverage or another significant change, such as an increase in the deductible, copayment, or out-of-pocket)
There is an addition or significant improvement in benefits package options
There is a significant change in coverage under your spouse's or dependent's employer plan
You, your spouse, or your dependent become eligible for Medicaid, Medicare, or other government-sponsored health plan
You, your spouse, or your dependent ceases to be eligible for Medicaid, Medicare, or other government-sponsored health plan

Changes in Your Residence

Judgments, decrees, or orders (including QMCSOs)
Gaining membership in a federally recognized tribe or status as an Alaska Native Claims Settlement Act (ANCSA) Corporation shareholder
Becoming a U.S. citizen
Leaving incarceration (jail or prison)
HIPAA special enrollment rights
COBRA qualifying event

What is Not Considered a Qualifying Life Event?

Employment-Related Changes

Reduction in work hours without loss of coverage
Changes in your employer's contributions, unless coverage is completely lost

Increase of Income

Getting a raise or bonus, or other increases in income

Personal Circumstances

Moving residences within the same coverage area
A change in your healthcare needs

Other Situations

Voluntarily dropping other coverage
Missing the new hire enrollment period
Missing the annual open enrollment period

This information is for reference only and does not guarantee the acceptance of any life event or coverage change. For more information, contact your employer's Human Resources Department or Benefits Manager, or reach out to Benefit Innovations.