Change your benefits with a qualifying life event

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. 

What kind of proof to submit

Your documentation must:

1. Include the date of the event.
2. Relate to the enrollment change you’re making (ex: If you submit a birth certificate, the baby must be added to your coverage). 

Here are examples of proof for each type of qualifying life event.

You or a dependent gained other coverage

• Screenshot from your member portal with the carrier name and first day of coverage
• Letter from the carrier with the carrier name and first day of coverage
• You can also call your new insurance company's Member Services Department and ask that “proof of creditable coverage” be faxed or emailed to you

You or a dependent lost other coverage

• Screenshot of your member portal with the name of the previous carrier and the last date of coverage
• Letter from the carrier with the name of the previous carrier and the last date of coverage
• You can also call your old insurance company's Member Services Department and ask that “proof of creditable coverage” be faxed or emailed to you

There was a change in your household

• Birth certificate or adoption papers
• Marriage license or certificate of civil union
• Divorce or legal separation papers
• Death certificate 

You or a dependent moved residences

• Change of address notice from the USPS
• A utility bill with your name and address

Part 1: Tell us about your qualifying life event 

1. Sign in to your Gusto employee account.
2. Head to the Benefits section.
3. If you have active benefits, click the link titled Any major life changes? Update your benefits.
   • If you don’t have active benefits, scroll to the "Health & Life" section and click Add Coverage.
   • If you don't see either of these options, your company's benefits are managed by another broker outside of Gusto. Reach out to your plan administrator for next steps. 
4. On the "Change your Benefits" page, click the drop-down menu to let us know the reason for changing your benefits. 
   • Insurance carriers set their own rules about which life events qualify you to make changes outside open enrollment. Check out common qualifying life events in the "What changes can I make with a QLE?" dropdown above.
5. Based on your reason for changing your benefits, a second drop-down will appear. Select the detail that applies to you.
6. Enter the date of the event.
   • The carrier’s deadline to submit the change is typically 30 days after the event. 
7. Click Upload Files to upload documentation of the event.
   • To approve the change, the carrier needs to review valid proof of the event. This can be a photo, screenshot, or copy of the documentation that includes the date of the event. You can find more documentation examples in the "What changes can I make with a QLE?" dropdown above.
8. Click Select File, or drag and drop your file to upload.
9. Click Continue.
   • For files over 8 MB, this may take 1 minute to process.

The next page returns you to your benefits dashboard to continue making your change.

Part 2: Verify your personal info

1. Once you're returned to your Benefits page, find the yellow sticky note on your dashboard labeled "Time-Sensitive Benefit Enrollments" and click Enroll or Waive.
   • The next page lists the benefits that your company offers and the date that the change will be effective. 
2. Click Get Started!
3. Verify your personal info. 
   • If you’re canceling coverage for any dependents, you can so on the next page.
4. If you’re not adding a dependent with this change, click Save & continue.
5. If you’re adding a dependent to coverage: 
   • Click Add dependent in the "Add a new dependent" box. 
   • In the pop-up, fill out your dependent's personal information and click Save.
   • To add more dependents, click Add dependent again.
   • Click Save & continue.

Part 3: See quotes and make your changes

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? 

• Check out this video to learn about the differences between plan types, common insurance terms, and a few examples with different people and the plan that best fits their situation.
• Cost: “Your cost” is the amount that’ll be deducted from each of your paychecks. Hover over the “i” icon to see the total monthly premium cost and what portion your company’s paying. 
• Coverage: click View full plan details to review each plan’s Summary of Benefits (SBC). This’ll help you understand how much you’d pay for common services you may need in the next year. Check out our guide to your SBC or call the carrier’s member service department for more info. 

Now you can see quotes and make your changes: 

1. For each line of coverage you want to change, click Enroll or Waive.
2. Next steps depend on the change you’re making to this line of coverage: 
   • Add dependent(s): click the checkbox next to the name of each dependent you’re adding.
   • Remove dependent(s): click the checkbox next to their name to remove the checkmark. 
   • Choose a new plan: if your company offers other options, click Select on the plan you want. 
   • Cancel coverage for yourself and any dependents: scroll to the “Waive Medical Coverage” tile and click Waive.
   • Keep your current plan: find the plan that already says “Selected.”
3. Click Save & continue. 
4. Repeat for each line of coverage you want to change.
5. Click Save & continue.
6. Answer the questions on the “Add Extra Info” page.
   • If you're waiving coverage, the carrier needs the reason for waiving to verify that your company meets their participation requirements.
7. Click Save & continue.

Part 4: Review and confirm your selections 

1. Review each line of coverage to make sure your new enrollment details are correct. 
   • To change any enrollments, scroll to the bottom of the page and click Back.
2. Scroll to “Forms you need to sign.”
3. Click Sign form beside each form.
4. To review a form, click on its name to open it in a new tab.
5. Draw your name in the signature field and check the box where it says, "I agree to electronically sign this form." 
6. Click Sign. 
7. Once you've signed each form, click Confirm Enrollment.

What comes next

• Submission to the carrier:
  • If Gusto's your broker, we'll prepare your paperwork and send your selections to the health insurance carrier.
  • If your company uses the broker integration, we'll notify your broker to submit your selections to the health insurance carrier. 
• Enrollment status: You can view the status of your enrollment from the sticky note in your Benefits section.
• Member ID and accessing care: Once the carrier processes your coverage, they'll mail you your member ID card. If you need to go to the doctor before your ID card arrives, check out the related information in this article.

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. 

1. Sign in to your Gusto employee account.
2. Head to the Benefits section.
3. Click Any major life changes? Update your benefits.
4. Choose I need to cancel my coverage. 
5. Select the reason for changing your benefits. 
   • Insurance carriers set their own rules about which life events qualify you to make changes outside open enrollment. Check out common qualifying life events in the "What changes can I make with a QLE?" dropdown above.
6. Enter the date of the event. 
7. Upload documentation of the event.
   • To approve the change, the insurance carrier needs to review valid proof of the event. This can be a photo, screenshot, or copy of the documentation that includes the date of the event. You can find more documentation examples in the "What changes can I make with a QLE?" dropdown above.
8. Click Continue.
9. Select each line of coverage you want to cancel. 
   • If you have an FSA: You cannot cancel an FSA mid-year, but you may be eligible to decrease your contribution. If you indicate that you want to change your FSA, we’ll reach out to you to confirm what changes you’re eligible to make. 
10. Choose Continue.
11. Review what your benefits will look like going forward, then click Looks good.
12. Click Sign form and enter your signature.
13. Once each form is signed, click Confirm cancellation. 

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.