Qualifying Life Event

A qualifying life event (QLE) is a major change in someone’s life that allows them to adjust their health insurance outside of the standard open enrollment period. In the U.S., open enrollment for 2025 runs through January 15 – but life doesn’t always line up neatly with enrollment calendars. That’s why QLEs exist.

Since the implementation of the Affordable Care Act (ACA) in 2010, QLEs (also known as Special Enrollment Triggers) have been a key element of consumer protection, allowing mid-year changes to pre-tax benefits under IRS Section 125.

If an employee loses health coverage, moves to a new zip code, has a baby, adopts a child, or experiences a change in marital status, they may qualify for a special enrollment period. This gives them about 60 days to make changes to their benefits plan.

For HR and People Ops teams, QLEs matter for two reasons:

1. Compliance: Ensuring the company follows federal and state rules around insurance coverage.
2. Care for Employees: Life changes are often stressful. Helping someone update their benefits quickly can make a real difference in how supported they feel at work.

What Counts as a Qualifying Life Event For Insurance?

Not every life change will open the door to new coverage, but a handful of categories are widely recognized as qualifying life events (QLEs). These events create a short-term opportunity (typically 30-60 days) for employees to enroll in a new health plan or update their existing one.

Below are the main types of QLEs, with examples all global HR teams should be prepared to handle.

1. Loss of Health Coverage

Losing health insurance can happen suddenly and leave employees feeling vulnerable. Whether it’s tied to a job change, aging out of a parent’s plan, or a shift in government program eligibility, this type of QLE ensures people have a chance to find new coverage without waiting for open enrollment.

Common Examples of This Type of QLE:

• Job-Related Changes: Termination, layoff, or reduced hours that eliminate access to employer-sponsored health insurance. For example, if a part-time worker’s hours are cut and they no longer qualify for benefits.
• Aging Off a Parent’s Plan: Turning 26 is a milestone in the U.S. healthcare system – dependents automatically lose coverage under a parent’s policy.
• Government Program Changes: Losing eligibility for Medicare, Medicaid, or CHIP (the Children’s Health Insurance Program) due to age, income, or residency changes.
• Divorce or Separation: When health coverage was previously tied to a spouse’s plan, the end of the marriage is a QLE.
• Other Circumstances: Loss of coverage through no fault of the employee. It’s important to note that losing coverage because of non-payment of premiums does not count as a QLE.

‍

‍

2. Changes in Household or Family Status

When family circumstances change, insurance needs usually change too. Getting married, welcoming a new child, or going through a separation are all moments where employees may need to update who’s covered under their plan.

Common Examples of This Type of QLE:

• Marriage, Divorce, or Legal Separation: Newlyweds can add a spouse; divorced employees may need to adjust coverage for themselves and their children.
• Having a Baby or Adopting: Adding a child to a plan requires documentation, such as birth certificates or adoption papers. Coverage often starts from the child’s birth or placement date.
• Placing a Child in Foster Care: Similar to adoption, foster placements expand a household and create the need for dependent coverage.
• Death of a Dependent: Losing a family member who was previously covered requires updating the plan.

3. Changes in Residence

A move doesn’t just mean a new address, it can also affect what health plans are available. If employees relocate to a new county, state, or zip code where their existing coverage no longer applies, that move qualifies as a QLE.

Common Examples of This Type of QLE:

• Relocating to a New County, State, or Zip Code: For instance, if a worker accepts a new role in another state, their current plan may not provide local coverage.
• Students Moving For School: A student relocating to or from college may need a new plan.
• Seasonal Workers: Moving to or from work-related housing (e.g., agriculture or hospitality jobs).
• Transitional Housing: Entering or leaving shelters or other temporary housing arrangements.
• Military Discharge or Moves from U.S. Territories: E.g., returning stateside from Puerto Rico.

‍

‍

4. Employment and Income Changes

A new job, a layoff, a big raise, or a sudden income drop can all change whether someone qualifies for employer coverage, Medicaid, or subsidies. These shifts give employees a chance to revisit their health plan and make sure it matches their new reality.

This could mean opting for a lower premium if they lose a job, or upgrading their plan if they get a new one that offers health benefits.

Common Examples of This Type of QLE:

• New Job or Job Loss: Starting a job that offers insurance, or leaving one that did. (Voluntary quits with coverage continuation, like COBRA election, don't qualify.)
• Income Changes: A raise, job loss, or other financial shifts that affect eligibility for Medicaid or premium subsidies under the ACA.
• Legal Status Changes: Becoming a U.S. citizen, permanent resident, or member of a federally recognized tribe.
• Release From Incarceration: Re-entering the workforce often makes someone newly eligible for employer-sponsored or government coverage. (Includes AmeriCorps service end.)

‍5. Changes in Legal or Citizenship Status

Shifts in legal or citizenship status can open new doors to health coverage. When someone gains eligibility through residency, citizenship, or other recognized changes, they don’t have to wait until open enrollment – they can enroll as soon as the change takes effect.

Common Examples of This Type of QLE

• Becoming a U.S. Citizen: Gaining full eligibility for marketplace or employer-based coverage.
• Gaining Permanent Residency (Green Card): Newly qualifying for health plans outside of open enrollment.
• Joining a Federally Recognized Tribe: Unlocking additional enrollment options and coverage flexibility.

6. Other Special Circumstances

​​Not every qualifying life event fits neatly into the standard categories. Some unique but important situations also trigger special enrollment, ensuring employees aren’t left without coverage when unusual or difficult circumstances arise.

Common Examples of This Type of QLE:

• Enrollment Errors or Misinformation: If incorrect details from an employer, broker, or marketplace impact coverage.
• Employer or Plan Violations: When a health plan fails to honor its coverage rules.
• Domestic Abuse or Abandonment Cases: Survivors are granted protections to secure coverage quickly.

‍

Ready to Level Up Your Benefits Package?

Qualifying life events are just one piece of the puzzle. From health insurance to retirement plans, benefits vary widely across borders. Explore our library of resources to learn how to design, scale, and manage benefits that support your teams everywhere.

Explore Global Benefits Guidance

‍

What is Not Considered a Qualifying Life Event?

It’s equally important to understand what doesn’t qualify as a QLE when it comes to insurance. Not every disruption in life triggers special enrollment. The below are excluded from this category:

• Voluntary Job Changes: Quitting a job while maintaining access to coverage isn’t a QLE.
• Normal Financial Challenges: Higher rent, grocery costs, or credit card debt don’t impact insurance eligibility.
• Local Moves: Relocating within the same coverage area usually doesn’t qualify.
• Non-Legal Household Changes: Moving in with a partner without a legal marriage or civil status change.
• Voluntary Plan Changes: Deciding to drop coverage or switch plans by choice isn’t recognized as a QLE.

Key Takeaway: Clear and accurate documentation – such as proof of qualifying life events, dependent eligibility records, and supporting forms – is essential to prevent misuse of benefits and ensure compliance. As an HR manager, always confirm what does and does not qualify as a QLE, and verify that all required documentation is properly collected and retained.

‍

‍

When Does Coverage Start After a Qualifying Life Event?

‍ Timing is critical when it comes to compliantly qualifying for a QLE. Employees typically have 30-60 days to act after a qualifying life event has taken place. The start of coverage also depends on the event type:

• Birth or Adoption: Coverage usually begins retroactively on the child’s birth or placement date.
• Loss of Coverage: New coverage usually starts the day after the old plan ends, so there’s no gap.
• Marriage, Divorce, or Other Events: Coverage generally begins on the first of the month following enrollment.

‍

‍

What Documents Do You Need to Submit For a QLE?

Insurers will naturally need different official documents for different QLE’s. Here are the most commonly required ones for the respective life events:

Adding or Removing Dependents from Health Insurance Plan During a QLE

For most employees, the first time they actually use a qualifying life event is when they need to add or remove a dependent. This could include getting married, welcoming a baby, adopting a child, or going through a divorce. These are emotional moments, and the last thing people want is to get lost in paperwork or miss a deadline. That’s where HR can make a huge difference.

What Employees Need to Know

• The Clock is Ticking: Once a QLE happens, you usually get 30–60 days to make changes. That’s not a lot of time – especially if you’re juggling wedding plans or sleepless nights with a newborn. Miss the window, and you may have to wait until the next open enrollment period, which could leave a spouse or child uninsured for months.
• Proof is Part of the Process: Insurance carriers need documentation. That could be a marriage certificate to add a spouse, a birth certificate or adoption papers to add a child, a divorce decree to remove an ex-spouse, or a court order for custody or child support cases.
• Approval Isn’t Instant: Filling out forms and handing over documents doesn’t automatically update the plan. The insurance carrier still needs to sign off, which means HR should set expectations and keep you updated until it’s official.
• Court Orders Come First: If a judge orders a child to be added to a health insurance plan, the employer and insurer have to act right away – no waiting for paperwork cycles.
• Not Every Change Qualifies: Employees cannot remove dependents or alter coverage simply to reduce premium costs. Each change must be supported by a recognized qualifying life event and verified through appropriate documentation.

‍

Which countries have free healthcare in 2025?

‍

‍

How Should HR Managers Handle an Employee Qualifying Life Event?

Qualifying life events are where HR policies leave the page and meet real life. A wedding, a new baby, a divorce, or a sudden loss of health coverage aren’t just “insurance triggers.” They’re often some of the most emotional moments in an employee’s life. Handling them well is about striking the balance between compliance, process, and empathy.

Here’s how you as an HR professional, can turn QLEs into opportunities to show support and competence:

1. Establish Clear Policies

Don’t leave employees guessing. Define what counts as a QLE during onboarding, in benefits handbooks, and in your HRIS or benefits portal. Give concrete, relatable examples:

• “Turning 26 and losing coverage under a parent’s plan.”
• “Adopting a child and needing to add them to your plan.”
• “Moving to a new zip code where your current plan doesn’t apply.”

The more examples you share, the easier it is for employees to connect the dots when their own lives change.

2. Streamline Documentation

The fastest way to build trust in your team is to remove friction points. Instead of making employees hunt down requirements, create a QLE checklist for each type of event. For example:

• Marriage: Marriage certificate + dependent enrollment form.
• Loss of Coverage: Termination notice from employer/insurer.
• Birth or Adoption: Birth certificate, adoption papers, or placement documents.

Also, make deadlines impossible to miss. Some carriers give 30 days, others 60. You need to spell that clearly and in plain language for your team. Here’s a template example of what to say:

“You have 60 days from the date of your marriage to add your spouse to your plan. If you miss this window, you’ll need to wait until the next open enrollment period.”

3. Use Technology to Support

Investing in good benefits management or administrative technology can also take a lot of stress out of the process, for both HR and employees. We recommend choosing a tool that can:

• Automate reminders so employees don’t lose track of deadlines. A simple email or portal alert halfway through the 60-day window can make all the difference.
• Digitize document collection. Instead of scanning and emailing sensitive records, give employees a secure upload option.
• Track approvals. Let employees see the status of their request (submitted → under review → approved) so they aren’t left wondering if coverage went through.

4. Offer Guidance and Flexibility

Even with policies and tech in place, QLEs can feel overwhelming. It’s your job as HR to translate “insurance language” into human language and guide your team through their choices. That might mean:

• Explaining what plan tiers are available after they add a dependent.
• Walking through how costs will change after losing eligibility for Medicaid.
• Helping employees compare options if they’re moving zip codes and need a new network.

‍

‍

Qualifying Life Event in a Nutshell

A qualifying life event (QLE) is what allows employees to update their health insurance outside the standard open enrollment period. Marriage, divorce, childbirth, adoption, moving to a new zip code, or losing health coverage all count. These events open a 60-day special enrollment period, giving employees time to add dependents, choose a new plan, or adjust coverage to match their needs.

For HR teams, QLEs are a chance to support employees during major life moments. Tools that integrate all of your other tools into one centralized dashboard, like Playroll’s global benefits platform, make managing these transitions seamless, compliant, and stress-free across