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Qualifying life event (QLE)

Typically, the only time you can change insurance coverage is 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 of open enrollment. This can be an event like a marriage or a dependent gaining other coverage through a new job. 

The deadline to make changes is 30 days after the event. If the carrier approves the change, it will either become effective as of the event date, or on the first of the month following the event. 

Change your benefits in Gusto

If your benefits are managed by Gusto, you can change your benefits in Gusto. You must provide documentation of the event for the carrier to review — here’s a list of valid types of proof.

Changes you can make with a QLE

  • Enroll in or decline coverage
  • Add or remove dependent(s) from coverage
  • Change your plan
    • To switch plans, your company must already offer other plan options

Qualifying events that you or your dependents may experience

  • Gaining or losing other coverage
  • Marriage or civil union
  • Divorce or legal separation
  • Birth or adoption of a child
  • Death of a spouse or child
  • Court-ordered mandate to cover a dependent
  • Change in residence or work location that leads to a change in your benefits eligibility
  • Aging out of dependent coverage

Insurance carriers make their own rules about which events they accept as QLEs. If an event you experienced is not on this list, the next chance to make changes is at your company’s annual open enrollment.

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