Change your benefits with a qualifying life event

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 and valid proof in Gusto within 30 days after the event. You can submit it as early as the day of the event. Each employee must enroll or waive in their Gusto account—admins cannot make enrollment changes on their behalf.

If your request is approved, the insurance carrier determines the effective date of the change. If the QLE is submitted on time and accepted by the carrier, most carriers backdate the effective date of the change to the date of the event. We'll update your benefit details in Gusto once approved.

Change your benefits in Gusto

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 below 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.

Before you start: Gather proof of the 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:

Include the date of the event
Full name(s) of individuals affected
Type of coverage affected
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, full name of individuals covered, effective start date, and type of coverage
Letter from the carrier with the carrier name, full name of individuals covered, effective start date, and type 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 with the newborn's full name and date of birth/adoption
Marriage license or Domestic Partnership with the full name of each individual and date of marriage/ partnership
Divorce or legal separation papers with a finalized divorce decree or loss/gain of other coverage
Death certificate

You or a dependent moved residences

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

Some carrier(s) may not allow screenshots as proof of loss/ gain of coverage and specific required documentation differs across our carriers. Gusto may reach out for further documentation depending on the carrier.

Enroll, change plans, or add/remove dependents

Part 1: Tell us about your qualifying life event

Sign in to your Gusto employee account.
Head to the Benefits section.
If you have active benefits, click Any major life changes? Update your benefits.
- If you do not have active benefits, scroll to the "Health & Life" section and click Add Coverage.
- If you do not 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.
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 below.
Based on your reason for changing your benefits, a second drop-down will appear. Select the detail that applies to you.
Enter the date of the event.
- The carrier’s deadline to submit the change is typically 30 days after the event.
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 below.
Click Select File, or drag and drop your file to upload.
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

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.
Click Get Started!
Verify your personal info.
To review your dependents, scroll to "Your dependents."
- All dependents should be listed here whether or not you're enrolling them—you’ll enroll or un-enroll them from benefits on the next page.
- If any dependents have aged out of eligibility for coverage, they're listed under a section called "Ineligible for coverage."
To add a dependent to the "Your dependents" list:
- Find the "Add a new dependent" tile and click Add dependent.
- Fill out their personal information and click Save.
- To add more dependents, click Add dependent again.
To remove a dependent from your list of dependents:
- Click Edit.
- Click Remove. If this does not work, proceed to the next page, where you can un-enroll the dependent from coverage.
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:

For each line of coverage you want to change, click Enroll or Waive.
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.”
Click Save & continue.
Repeat for each line of coverage you want to change.
Click Save & continue.
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.
Click Save & continue.

Part 4: Review and confirm your selections

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.
Scroll to “Forms you need to sign.”
Click Sign form beside each form.
To review a form, click on its name to open it in a new tab.
Draw your name in the signature field and check the box where it says, "I agree to electronically sign this form."
Click Sign.
Once you've signed each form, click Confirm Enrollment.

What's 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.

The insurance carriers take 1–3 weeks to review requested changes.

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.

Cancel coverage

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.

Sign in to your Gusto employee account.
Head to the Benefits section.
Click Any major life changes? Update your benefits.
Choose I need to cancel my coverage.
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 below.
Enter the date of the event.
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 below.
Click Continue.
Select each line of coverage you want to cancel.
- If you have a Flexible Spending Account (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.
- Short-term disability, long-term disability, and life insurance: These plans cannot be waived because your company pays 100% of the premiums. The insurance carrier automatically enrolls all eligible employees in these plans.
Choose Continue.
Review what your benefits will look like going forward, then click Looks good.
Click Sign form and enter your signature.
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.

What counts as a QLE?

Qualifying life events that you or your dependents may experience

Gaining other coverage
Losing other coverage involuntarily (including COBRA or continuation coverage)
Marriage or domestic partnership
Divorce or legal separation
Birth or adoption of a child, or placement of a foster child
Death of a spouse or child
Court-ordered mandate to cover a dependent
Moving in or out of a service plan area
Moving to or from another country
Aging out of dependent coverage (The age at which you become ineligible to be a dependent on another plan is state-specific.)
Gaining U.S. citizenship

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.

Qualifying Life Events are set by the Federal Law. HIPAA provides special enrollment periods for employees and dependents due to loss of eligibility and specific qualifying life events. Additionally, HIPAA prohibits discrimination of our customers and their families based on any health factors they may have, including prior medical conditions, previous claims experience, and genetic information.

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.

What changes can I make with a QLE?

Changes you can make with a QLE

Enroll in coverage
Cancel coverage
Add or remove dependent(s) from coverage
Change your plan

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. It must include the full name of the affected employee, each affected dependent, and the date of the event. If your life event is not submitted timely, Gusto reserves the right to deny your life event changes.

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	Accepted documents	The document must include...
Birth or adoption	Enroll in or change coverage for yourself and/or new dependents The affected newborn must be included in the addition to coverage or plan change request	Finalized birth certificate Hospital record of birth Adoption letter or record	Newborn’s full name Date of birth
Marriage	Enroll in new coverage for you/ your spouse Add spouse and/or new dependents to coverage	Finalized marriage certificate (from city clerk’s office)	Full name of each individual (employee and spouse) Date of marriage
Marriage	Waive coverage for yourself/any dependents, if moving to spouse’s coverage	Proof from the new insurance carrier	Full name of each individual (employee and partner) Date the certificate was signed
Domestic partnership	Enroll in new coverage for you and your partner Add your domestic partner to coverage	Certificate of Domestic Partnership State Participant	Full name of each individual (employee and partner) Date the certificate was signed
Domestic partnership	Waive coverage for yourself and any dependents	Proof from the new insurance carrier	Proof of new coverage with full names, effective start date, and lines of coverage All dependents must be listed
Divorce or legal separation	Enroll yourself in coverage Add dependents to coverage	Letter of cancellation from your previous carrier with the end date of coverage for you and each affected dependent Divorce decree	Prior coverage lost must include all individuals' full names, lines of coverage and end date of coverage A divorce decree is valid proof to enroll an employee into coverage Divorce must be finalized
Divorce or legal separation	Waive spouse and/or dependents from coverage	Finalized divorce decree Proof from spouse or dependent's new insurance carrier	Finalized divorce decree with all individuals' full names and date of divorce Proof of new coverage with all individuals' full names, line(s) of coverage, and coverage start date
Court order to cover dependents	Enroll self and dependent(s) in coverage	Copy of finalized Court Order National Medical Support Notice (NMSN)	Employee and all dependents (full names) and order date must be listed on the National Medical Support Notice (NMSN) to be enrolled
Aging out of parent’s coverage	Enroll in new coverage	Letter of cancellation from your previous carrier Proof from prior insurance carrier	Full name(s) of all individuals looking to enroll in coverage End date of previous coverage
You gained other coverage	Waive coverage for you and your dependents	Proof from the new insurance carrier	Full name(s) of all individuals looking to waive coverage Effective date of new coverage Line(s) of coverage
Dependent gained other coverage	Waive coverage for your dependent(s)	Proof from the new insurance carrier	Full name(s) of all individuals looking to waive coverage Effective date of new coverage Line(s) of coverage
You lost other coverage	Enroll in coverage for yourself and dependents	Letter of cancellation from your previous carrier Employer letter on company letterhead	Full name(s) of all individuals looking to enroll in coverage Line(s) of coverage End date of coverage lost
Dependent lost other coverage	Enroll dependent in coverage Change plans to support added dependent(s)	Letter of cancellation from the previous carrier Employer letter on company letterhead	Full name(s) of all individuals looking to enroll in coverage End date of previous coverage Line(s) of coverage lost
Relocation (Must have moved in or out of HMO plan area to be eligible)	Waive HMO coverage if you or a dependent have moved out of the HMO plan service area and become ineligible for coverage due to the move Change plans from an HMO to a PPO plan due to becoming ineligible for the HMO coverage due to move Enroll in HMO coverage if you or your dependent has become eligible for coverage due to a move	USPS change of address confirmation Bills for financial statements showing a change of address Documentation for mortgage or rent	USPS change of address confirmation with the date of the address change, your full name, full names of dependents affected Financial statement including your full name, full names of dependents affected, address and recent date Mortgage/rent document including your full name, full names of dependents affected, address and move-in date See overview of medical plan types (HMO, PPO, POS, etc.)
International relocation	Waive coverage if you or a dependent have moved to another country Enroll or change coverage if you or your dependent have moved to the U.S. from another country	An Arrival or Departure Record (I-94) A stamped passport Stamped Visa New country/foreign Residency permit	I-94 with all affected individuals' full names and date of entry or departure Stamped passport for each affected individual and recent entry date Visa that contains your name and/or each affected dependent name(s) and is stamped with a recent entry date for each individual affected New country/foreign Residency permit with employee and/or each affected dependent name(s) and a recent issue date
Death of employee	Waive coverage for the employee	Death certificate	Name of employee Date of Death
Death of a dependent	Cancel coverage for the dependent	Death certificate	Name of dependent Date of Death
Gaining U.S. citizenship	Enroll yourself and/or affected dependents in coverage	A certificate of U.S. citizenship	Full name of individual(s) and date of issuance

Dental and vision coverage is not a voluntary line of coverage. You will be required to provide valid proof to change these lines of coverage mid-year.

Court order to cover dependents

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:

The employee should enroll the dependent from their Gusto account within 30 days of the date on the order—follow the steps above under "Change your benefits in Gusto." When prompted, upload a copy of the court order.
If the employee does not take action to comply with the court order in time, the employer may reach out to Gusto, and we’ll help to enroll them.

If you offer benefits outside of Gusto:

Work with your broker to enroll the employee’s dependents.
If you need to collect contributions from the employee, you can then set up a benefit deduction to collect any employee contributions and report company contributions.
If the employee does not take action to comply with the court order in time, reach out to your broker for next steps on complying with the order.

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.