Make it easier for you and your employees during a qualifying life event

A qualifying life event (QLE) is a change in an employee’s life, such as marriage, divorce, having a child or a spouse losing their health coverage, that can make the employee eligible for a special enrollment period.

This special enrollment period is a time span (usually between 30-60 days) outside of open enrollment where employees can sign up for new health insurance following a QLE.

QLEs present a multitude of challenges for employers. They’re unpredictable and could occur at any time in an employee’s life, making QLEs disruptive to HR operations. Legal documents (such as a birth certificate for a newborn child) are required to verify eligibility for the QLE special enrollment period, which can be hard to track and share with HR—especially for remote employees. The documentation sharing process is time-consuming and can lead to a lot of “back and forth” between HR and the employee—add in the short 30-60-day timeframe to complete the process, and it’s a headache and time sink for both parties. Since these documents need to be stored for up to 7 years (depending on the type of QLE) in the employer’s benefits administration system to meet the Department of Labor’s regulations, it’s a process that cannot be overlooked—or else risk penalties for non-compliance.

The following events count as a qualifying life event and trigger the special enrollment period:

  • 1. Loss of health coverage

    • Losing existing coverage, including job-based, individual and student plans
    • Turning 26 and losing coverage through a parent’s plan
    • Losing eligibility for Medicare, Medicaid or CHIP

  • 2. Changes in household

    • Getting married or divorced
    • Having a baby or adopting a child
    • Death in the family

  • 3. Changes in residence

    • Moving to a different zip code or county

  • 4. Other qualifying life events

    • Changes in your income that affect the coverage you qualify for
    • Becoming a U.S. citizen

Optavise’s Qualifying Life Event administration service

With Optavise’s Qualifying Life Event Administration Service, we remove the administrative burden from your HR team by providing licensed benefits educators who are dedicated to assisting your employees with the QLE process. These benefits educators will:

  • Provide guidance during the transition, helping employees understand what does (or does not) count as a qualifying life event.

  • Educate employees on how the life event could impact their pre-tax benefits and facilitate the changes needed to their benefits coverage.

  • Communicate deadlines and the required materials needed,as well as any penalties that inaction could produce.

  • Oversee the collection,distribution, and storage of required legal documents in the employer's benefits administration system.

The result is a variety of benefits for both employers and employees, including:

Optavise guides employees to make better health care decisions with individualized education for selecting the right benefit plan, expert assistance in making informed care choices and rewards for sensible financial decisions. Its customers experience significant ROI on their benefits investments through increased employee participation, management of the evolving regulatory environment and reduced cost through health care cost transparency.

  • Employer benefits

    • Streamlined process to educate, communicate, and enroll employees in benefits following QLEs.
    • Eliminates errors that come from the “back and forth” sharing of legal documentation.
    • Reduced administrative burden on the HR team, allowing them to focus on other business priorities.
    • Qualified, licensed benefits educators help with both primary (health, dental) and voluntary benefits.
    • Provides a “one-stop shop” for QLE management— no other third parties are required.

  • Employee benefits

    • Provides a single resource to guide employees through the QLE process.
    • Allows for a smooth transition into a new stage in the employee’s life.
    • Increases employee satisfaction through improved appreciation and understanding of their benefits options.