Qualifying Events

Common Types of Qualifying Events

Health Insurance is insurance meant to cover all or most of your expenses during medical events. During open enrollment, you select a plan and benefits that best fit your financial situation and your circumstances, then that plan is in effect–usually for a year–until the next enrollment period. Life changes during the course of that year can alter your insurance needs.

Certain qualifying life events make you eligible to change your insurance benefits before the next enrollment period.

Check with your insurance provider to find out what the window of opportunity is for making changes to your benefits after a qualifying event occurs. You may have only 30 or 60 days to notify your carrier and provide documentation to support your qualifying event. Some providers may require as little as seven days notification.

The following list represents examples of common types of IRS qualifying events.

• Change in legal marital status or in a domestic partnership status

• Change in the number of eligible dependents of the employee or dependents of the domestic partner

• Gain Dependent—birth, adoption, placement for adoption, stepchildren etc.

• Loss of Dependent—dies or reaches age 26 unless disabled as defined under the eligibility section.

• Change in employee’s, spouse’s, domestic partner’s, or dependent’s employment status (commencement or termination of employment, strike or lock-out, unpaid leave, etc.)

• Gain / lose entitlement to Medicare or Medicaid

• A change in residence of the employee, spouse, domestic partner or eligible dependent, which affects eligibility for coverage

• Judgment, decree, or Qualified Medical Child Support order for health coverage of an eligible child

• Significant change in health coverage of an eligible child

• Significant change in coverage or cost of dependent’s plan.

The type of IRS approved qualifying event determines the changes that are permissible. For example, marriage of the employee would permit a change from employee only coverage to employee + 1 coverage.