What is a Qualified Life Event?

You should always elect benefits during open enrollment to ensure you get the coverage you need; however, once enrolled in health coverage like a cafeteria or section 125 plan, you are unable to change your elections until the plan year ends. But sometimes qualified life events occur, allowing you to change elections outside the standard enrollment period.

I can change my elections midyear?

  1. You must experience a midyear election change event recognized by the IRS.
  2. The cafeteria plan must permit made your election changes for that event.
  3. Your request to change must be consistent with the midyear election change event.

How do I qualify?

Qualified events can be specific to individual plan offerings, but some common examples can be found below:

  • Change in status legal name, marital status, number of dependents and others
  • Significant plan cost changes
  • Significant curtailment of coverage
  • Change in coverage under other employers plan
  • Addition or significant improvement of benefit package option
  • FMLA leaves of absence
  • Loss of group health coverage sponsored by a government or educational institution
  • COBRA qualifying events
  • HIPPA special enrollment events
  • Medicare or Medicaid entitlement

Please know that certain qualified events can complicate health plan enrollment. For more information on qualifying events, please contact your HR department or plan administrator.  Click HERE to download infographic.

This article is not intended to be exhausted nor should any discussion or opinions be construed as legal advice. Readers should contact legal counsel or an insurance professional for appropriate advice.  © 2016 Zywave, Inc. All rights reserved.