Typically, the only times you can change insurance coverage are as a new hire or newly eligible employee, or during your company’s annual open enrollment. The exception is if you or your dependent experience a Qualifying Life Event (QLE). A QLE is an event that your insurance carrier considers to be a valid reason to change your benefits outside open enrollment. This can be an event like a marriage or a dependent gaining other coverage through a new job.
Make sure to submit your QLE request and valid proof of the event in Gusto within 30 days of when your life event took place. Carriers take 1–3 weeks to review requested changes. If your request is approved, the carrier determines the effective date of the change and we'll update your benefit details in Gusto.
Qualifying life events that you or your dependents may experience
A voluntary drop or cancellation of coverage does not qualify for a special enrollment or QLE—the loss of coverage must be involuntary. Canceling the plan or failure to pay the premiums are considered voluntary losses of coverage and therefore are not qualifying life events.
Whether a life event counts as a qualifying life event is ultimately up to your insurance carrier. If an event you experienced is not on this list, your next chance to make changes is at your company’s annual open enrollment.
Changes you can make with a QLE
Qualifying life events and required documents
Insurance carriers require proof of a qualifying life event and timely submission of your request to approve changes. Valid proof must be submitted in Gusto within 30 days of the event and must include the full name of the affected employee, each affected dependent, and the date of the event.
Whether a life event counts as a qualifying life event is ultimately up to your insurance carrier. Here's a list of common qualifying life events and the documentation required for each:
Event | Changes you can make | Acceptable documentation |
Birth or adoption |
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Marriage |
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Marriage |
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Domestic partnership |
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Domestic partnership |
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Divorce or legal separation |
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Divorce or legal separation |
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Court order to cover dependents |
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Aging out of parent’s coverage |
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You gained other coverage |
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Dependent gained other coverage |
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You lost other coverage |
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Dependent lost other coverage |
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Moved in or out of plan area |
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International relocation |
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Death of a dependent |
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If an employee of your company receives a court order to enroll their dependents in health insurance, the primary administrator of your company will receive a National Medical Support Notice (NMSN). This is sent by a local support agency to make sure that children receive health care coverage when it's available and required as part of a child support order.
Next steps
If health benefits are available to the employee, they should add the dependents to their coverage. A court order counts as a qualifying life event, meaning the employee can enroll themselves and their dependents outside open enrollment.
How to enroll
If you offer benefits through Gusto, including the broker integration:
If you offer benefits outside of Gusto:
Keep in mind: The employer must adhere to limitations imposed on withholding as mandated by withholding laws of the state where the employee is principally employed. Check the state’s laws and consult your HR professional to learn more.
If your company offers benefits through Gusto (including the broker integration), you can view or change your benefits from your employee account. If your company offers benefits through another broker, contact your broker to make changes.
If you or your dependent have a qualifying life event and documentation for it, follow the steps below to see quotes and add, remove, or change your insurance coverage (including adding or removing dependents). Most carriers require that you submit your changes within 30 days of the event date.
Click the "What changes can I make with a QLE?" dropdown above to review the required documentation by QLE type.
If you're enrolling as a new hire or during your open enrollment, follow the steps in this article instead.
To submit a qualifying life event (QLE) and change your or your dependents’ insurance coverage outside of open enrollment, your insurance carrier will ask you to provide dated proof of the event.
Your documentation must:
Here are examples of proof for each type of qualifying life event.
You or a dependent gained other coverage
You or a dependent lost other coverage
There was a change in your household
You or a dependent moved residences
The next page returns you to your benefits dashboard to continue making your change.
The next page lists each line of coverage your company offers. If you’re currently enrolled in a plan, your plan name is listed. This is where you can make your changes (add, change or remove coverage, and add or remove dependents).
Want help figuring out which plan is best for you?
Now you can see quotes and make your changes:
If you’ve experienced a qualifying life event that allows you to cancel your insurance plan, here’s how to request your cancellation in Gusto.
We’ll submit your request to the insurance carriers and let you know if they require any other information.
Last day of coverage: Your insurance carrier will make the final decision on the last day of coverage, but this is often the last day of the month that the qualifying life event occurred in. Your Gusto account will include the last day of coverage once the carrier confirms.