Organizational Wellness

Qualifying Life Events for Employee Insurance: An HR Leader's Guide

Last Updated Nov 27, 2024

Time to read: 10 minutes

Is your qualifying life event (QLE) management process more chaotic than a toddler’s birthday party? If you’re struggling to figure out what you can do to support employees during major life events, then you deserve to take some time to develop a QLE management strategy.

Whether you’re dealing with newlyweds, new parents, or newly relocated employees, how you manage these transitions can make or break your reputation as an employer who really cares. In fact, managing changes was cited as the top challenge for HR professionals by almost half of respondents in a PwC survey.

But don’t worry, because by the end of this article, you’ll know exactly how to identify and manage a QLE with ease. Your employees, managers, and benefits brokers will thank you!

What is a Qualifying Life Event?

A QLE is a significant change in an employee’s life that allows them to make adjustments to their insurance coverage outside the annual open enrollment period. It's an opportunity to reset benefits when life shifts—whether it’s getting married, having a baby, or changing jobs—because life doesn't only evolve on a schedule. This gives employees the flexibility to adjust their coverage to fit their new reality so they are still protected.

Common Qualifying Life Events

Life has a way of keeping us on our toes, and QLEs are the insurance world’s way of keeping up. Here are the most common life plot twists for employees that qualify:

Marriage or divorce: Tying the knot or untying it both count as QLEs. Whether you’re saying “I do” or “I don’t anymore,” your insurance needs are likely to change. Getting married might mean adding your spouse to the plan, while splitting up could mean removing them quickly. This might be the most common type of QLE, as there are over 2 million new marriages and almost 675,000 divorces every year in the U.S., according to the CDC.
Childbirth or adoption: Welcoming a new family member, whether through birth or adoption, is a major life change that qualifies. It’s time to add that little bundle of joy (and medical expenses) to your insurance plan. It’s important to support working parents during this time, as 80% of caregivers think that becoming a parent impacted their work, according to a Harvard Business School report.
Loss of health coverage: If you lose your existing coverage, then you’ve got a QLE on your hands. Maybe your spouse lost their job or you aged out of your parents’ plan. It’s the insurance equivalent of musical chairs — when the music stops, you need to find a new seat quickly.
Change in residence: Moving to a new zip code can be a QLE, especially if it means you’re outside your current plan’s service area. This will allow you to pick a new health plan that’s more suitable to your new neighborhood.
Change in employment status: Starting a new job, getting promoted, or having your hours reduced can all trigger a QLE.
Dependent aging out: When your child hits 26, they’re too old for your insurance plan.
Change in income: A significant income change might make you eligible for different plans or subsidies.
Death in the family: A somber reminder that life changes can require insurance changes.

Documentation Requirements

You can’t claim a QLE without proper documentation. For different QLEs, you’ll need different types of proof:

Marriage: Marriage certificate
Divorce: Divorce decree
Birth or adoption: Birth certificate or adoption papers
Loss of coverage: Letter from the previous insurer
Change in residence: Proof of new address
Employment change: Letter from employer

Qualifying Life Events and Health Insurance

When a QLE hits, it triggers a special enrollment period (SEP). It’s a window of 30 to 60 days to make changes to your health insurance. Think of it as a pop-up shop for insurance changes — here for a limited time only. The SEP lets you:

Enroll in a new plan if you didn’t have coverage before
Switch to a different plan if your current one doesn’t fit your new situation
Add or remove dependents from current plans

This window of opportunity allows employees to adjust their coverage to match their new life circumstances outside the open enrollment period. Missing this window is like missing the last train home — you might be stuck with unsuitable coverage until the next open enrollment comes around. It’s important to note that the time starts ticking from the date of the qualifying event, not from when the employee notifies their employer or insurer.

Other Types of Insurance Impacted by QLEs

While health insurance gets the spotlight, other types of insurance might also need adjusting when a QLE occurs:

Life insurance: Getting married or having a kid might make you realize you need more coverage. It’s time to think about your loved ones financially if something were to happen to you. This is becoming more popular, as more than half of people have some type of life insurance, according to Limra’s 2023 Life Insurance Fact Sheet.
Disability insurance: A change in income or employment status could affect your disability insurance needs. If your income has increased, then you might want to boost your coverage to maintain your lifestyle if you become unable to work.
Dental insurance: Because that new spouse or kid will need their pearly whites taken care of, too. Don’t forget about those potential orthodontic costs down the line.
Vision insurance: Adding dependents to your plan? Don’t overlook the importance of eye care. From annual check-ups to potential glasses or contacts, vision insurance helps keep everyone’s eyesight sharp.
Long-term care insurance: Major life changes might make you reconsider your long-term care needs. Whether you’re getting married, having a child, or experiencing a change in health status, it’s worth evaluating if long-term care insurance should be a part of your financial planning.

Navigating Qualifying Life Events: HR's Role

For the HR professional, managing QLEs is like being a combination of air traffic controller, detective, and therapist. You’re guiding employees through turbulent life changes, verifying their stories, and providing support all the time. Let’s break down this juggle into manageable pieces.

HR's Responsibilities

Here's your to-do list for handling QLEs:

Informing employees about QLEs and SEPs: After learning about an employee’s QLE, it’s your responsibility to deliver the good news about QLEs and SEPs. Help them understand how they can change their benefits and why they might want to.
Verifying documentation and approving enrollment changes: Time to verify those QLEs. This includes checking birth certificates, marriage licenses, and change of address forms. Once you’ve confirmed the evidence, you can start approving qualifying changes.
Communicating with insurance carriers: You’re the middle person between your employees and their insurance carriers. It’s like being a translator, but instead of languages, you’re translating life events into insurance-speak. You’ll be updating carriers about changes, confirming coverage is active when it should be, and generally keeping the lines of communication open.
Maintaining accurate records: Your filing system needs to be well organized. Keeping accurate records of QLEs, changes, and communications is super important.

Common QLE Challenges & Solutions

Managing QLEs isn’t all smooth sailing. Here are some common challenges to watch out for and how to solve them:

Challenge: Time constraints and administrative burden

You might feel like you’re constantly racing against time, trying to process changes before the SEP window closes. The paperwork piles up faster than dirty dishes, so it’s important to move quickly.

Solution: Welcome to the 21st century, where robots can help you manage QLEs. Investing in good benefits administration software can automate notifications, track deadlines, and even help verify documentation. Look for systems that can send automatic reminders to employees, flag incomplete submissions, and generate reports at the click of a button.

Challenge: Ensuring compliance with regulations

Employee benefits are highly regulated. Keeping up with all the rules and regulations can feel like trying to memorize the phone book.

Solution: Develop clear policies and procedures. Create a top-notch QLE playbook. Having step-by-step procedures for each type of QLE can turn a complex process into a simple checklist. Regularly review and update these procedures to reflect any changes in regulations or company policy.

Challenge: Communicating effectively with employees

Explaining QLEs and their implications is complex, and your audience might not always be fully engaged.

Solution: Provide comprehensive employee education. Knowledge is power, and in this case, it’s also sanity. The more your employees understand about QLEs and how to handle them, the smoother the process will be for everyone. Create a benefits communication strategy that would make any teacher proud. You can use a variety of methods like infographics, videos, and interactive tools to make the information more digestible.

Supporting Employees Through Life Transitions

Remember, behind every QLE is a human being going through a significant life change. Your role goes beyond just processing paperwork — you’re a support system in HR clothing.

Empathy & Communication

When an employee comes to you with a QLE, they might be experiencing one of the best or worst moments of their life. Your response should be empathic. Listen actively, communicate clearly, and remember that a little kindness goes a long way.

Clear communication is your best response here. Explain the process, the timelines, and the implications in a way that’s super easy to understand. Use multiple channels, including emails and face-to-face meetings.

Resources & Assistance

Your support shouldn’t stop at benefits enrollment. Consider offering plenty of resources to help employees navigate their life changes:

Employee assistance programs (EAPs): These offer comprehensive support for life problems. From counseling services to legal advice, EAPs can provide crucial support during stressful life transitions.
Financial wellnessprograms: Many QLEs have financial implications, such as a divorce or a new child. Nearly one-quarter of employees say that financial worries decrease their productivity at work, according to a 2024 SoFi survey. Offering financial education or counseling can be like giving your employees a life jacket in choppy financial waters.
Flexible workarrangements: Life changes often come with new responsibilities or challenges. For example, almost three-quarters of working parents have considered altering their work schedule, changing jobs, or leaving their jobs, according to an SHRM survey. Flexible work options can provide some much-needed flexibility as employees try to balance their new normal with work obligations.

Proactive Approach

Don’t wait for the QLEs to come to you — be the early bird that catches the worm. Being proactive can give you and your employee some critical extra time to work on making benefits adjustments during the SEP window. Here’s what you can do about it:

Anticipate and address potential issues: Use your HR crystal ball to foresee common QLEs and prepare for them. If you know somebody has paternity leave scheduled, have those new parent resources ready to go.
Conduct regular benefits reviews: Don’t wait for open enrollment to check in with employees about their benefits. Regular check-ins can help catch any life changes that might have slipped through the cracks.
Provide ongoing employee education: Make benefits education a year-round sport, not just an annual event. The more your employees understand their benefits, the better equipped they’ll be to handle QLEs when they arise.

Empower Your Employees with Expert QLE Management

Navigating QLEs doesn’t have to be a maze of confusion and stress. By implementing a comprehensive QLE management strategy, you can turn these life transitions into opportunities to demonstrate your company’s commitment to employee wellbeing.

A well-designed employee wellbeing program can complement your QLE management efforts, providing crucial support during life’s big moments. By integrating wellness initiatives with your benefits administration, you create a holistic approach that supports employees through all of life’s changes, big and small. As revealed in Wellhub’s Return on Wellbeing 2025 report, 61% of workers with wellbeing benefits report being happy or extremely happy with their current company. In contrast, satisfaction plummets to a downtrodden 36% among those without these benefits.

Wellhub specializes in creating tailored wellbeing programs that work hand-in-hand with your overall employee wellness strategies. Our team of experts can help you develop initiatives that provide emotional, financial, and physical support during life transitions. Speak to a Wellhub Wellbeing Specialists today to see how we can help!