How to Approve a Qualifying Life Event

Understanding what a qualifying life event is and how to approve one in Fingercheck.

Jeffrey Mo avatar
Written by Jeffrey Mo
Updated over a week ago

Qualifying Life Events (QLEs) are pivotal moments in the lives of employees that can trigger changes in their health insurance coverage. As an employer, understanding and effectively managing these events is crucial for providing support to your workforce and maintaining a smooth benefits administration process. Let's explore key aspects of QLEs and the role employers play in facilitating these transitions.


What is a qualifying life event?

A QLE is a significant life change that may impact an individual's health insurance needs. These events include, but are not limited to, marriage, birth or adoption, divorce, loss of other health coverage, and changes in residence.

When employees experience a QLE, they may be eligible to make changes to their health insurance coverage outside of the regular open enrollment period.


Employer responsibility during a qualifying life event

Effectively managing a QLE is not only a regulatory responsibility but also an opportunity for employers to demonstrate support for their employees during significant life changes. By establishing clear processes, maintaining open communication, and staying informed, employers can navigate a QLE with efficiency and empathy, contributing to a positive workplace experience for their teams.

Below are some recommended best practices to follow when an employee experiences a QLE:

  • Clear communication: Ensure that your employees are aware of the QLEs that may allow them to make changes to their health insurance coverage. Provide clear communication about the process, timelines, and required documentation.

  • Document verification: When employees submit documentation to support their QLE, carefully verify the authenticity of the documents. This may include marriage certificates, birth certificates, or other relevant proof depending on the nature of the life event.

  • Benefits administration: Promptly update benefits administration systems to reflect any changes resulting from QLEs. This includes adjusting health insurance coverage, updating beneficiary information, and making changes to other employee benefits.

  • Notification of changes: Communicate changes in benefits or coverage resulting from QLEs to the affected employees. Clearly outline any adjustments in premium amounts, payroll deductions, coverage start dates, or other relevant details.

  • Compliance with regulations: Stay informed about and ensure compliance with applicable regulations and laws related to QLEs. Regularly review and update policies to align with current legal requirements.

  • Employee assistance: Offer assistance and guidance to employees navigating the QLE process. Establish clear communication channels and provide access to resources that can help them understand their options.

  • Privacy and confidentiality: Maintain the privacy and confidentiality of employee information related to QLEs. Implement secure handling practices to protect sensitive personal data.

  • Record keeping: Keep accurate records of QLE-related transactions and communications. Organized record-keeping facilitates transparency, especially in case of audits or inquiries.

  • Stay informed: Stay informed about changes in healthcare and benefits regulations. Regularly update your knowledge to ensure that your company's policies align with current legal requirements.


Types of qualifying life events

There are a range of events that can qualify as a qualifying life event (QLE). The following are the most prevalent types of QLEs.

Loss of health insurance

  • Losing coverage through a parent’s insurance plan on your 26th birthday

  • Losing coverage due to a job loss, COBRA, or a student plan

  • Losing eligibility for Medicare, Medicaid, or CHIP

  • Losing health insurance for any reason other than not paying premiums

Changes in your household

  • Getting married, separated, or divorced

  • Adding a child to your family, such as giving birth, adopting a child, or taking care of a foster child

  • Experiencing the death of a family member enrolled on your health insurance

Changes in your residence

  • Moving to a different county or ZIP code

  • Students moving to attend school or back home from school

  • Seasonal workers moving to a work location or back home from a work location

  • Moving in or out of a shelter or transitional housing

Changes to eligibility

  • A change in income affects Medicaid eligibility

  • Becoming eligible for tax credits that lower premiums after enrolling in an ACA plan

  • Becoming a member of a federally recognized tribe

  • Becoming a U.S citizen

  • For AmeriCorps VISTA members, beginning or ending service

  • Being discharged from the military

  • Being released from incarceration


Documentation to establish a qualifying life event

Qualifying Life Events (QLEs) often require documentation to support the changes made to health insurance coverage. Proper documentation is essential for verifying the occurrence of the event and ensuring accurate processing.

Ensuring you have the appropriate documentation is crucial for a smooth and efficient processing of your health insurance changes during a QLE. Always check with your health insurance provider for specific documentation requirements related to your circumstances.

Below are common types of QLEs and the corresponding documentation that may be needed:

Loss of health insurance

  • Termination letter from employer

  • Proof of loss of coverage

  • Other relevant documents

Changes in your household

  • Marriage certificate

  • Legal documents for divorce or separation

  • Birth certificates, adoption papers, or placement documentation

  • Death certificate of the individual on the policy

Changes in your residence

  • Proof of new address, utility bills, or lease agreement

  • Proof of enrollment or change in residence for students

  • Employer verification or documentation of work location change

  • Shelter or housing facility confirmation

  • Proof of relocation and immigration documents for international moves

Changes to eligibility

  • Pay stubs, tax documents, or income verification

  • Documentation of eligibility for tax credits

  • Tribal membership documentation

  • Citizenship documents for new U.S. citizens

  • AmeriCorps documentation for beginning or ending service

  • Military discharge papers

  • Documentation of release from incarceration


Process a qualifying life event

Processing a Qualifying Life Event (QLE) in Fingercheck is a straightforward and efficient task. This streamlined process ensures efficient handling of a QLE, providing clarity and transparency throughout.

View QLE supporting documents

  1. Log in to Fingercheck as an Administrator.

  2. Hover your mouse over Insurance.

  3. Select Qualified Life Events.

  4. Click the paperclip.

  5. Select a link to open an attachment the employee uploaded as supporting QLE documentation.

If additional documentation is required from the employee, you can ask them to edit their existing QLE submission and attach additional files.

Approve a QLE

  1. Log in to Fingercheck as an Administrator.

  2. Hover your mouse over Insurance.

  3. Select Qualified Life Events.

  4. Click the hamburger menu and select Edit.

  5. Click Approve.

  6. Click OK to approve the QLE submission.

The QLE status will show as Approved.

Deny a QLE

  1. Log in to Fingercheck as an Administrator.

  2. Hover your mouse over Insurance.

  3. Select Qualified Life Events.

  4. Click the hamburger menu and select Edit.

  5. Click Deny.

  6. Click OK to deny the QLE submission.

The QLE status will be shown as Declined.


FAQ

What is a qualifying life event (QLE)?

A QLE is a significant life change that may impact an individual's health insurance needs, allowing employees to make changes to their coverage outside the regular open enrollment period.

What are examples of qualifying life events?

Examples include marriage, birth or adoption, divorce, loss of other health coverage, changes in residence, and changes to eligibility. See the comprehensive list provided in the documentation.

What is the employer's responsibility during a QLE?

Employers play a crucial role in effectively managing QLEs. Responsibilities include clear communication, document verification, benefits administration updates, notification of changes, compliance with regulations, employee assistance, privacy maintenance, record-keeping, and staying informed.

What types of documentation are required for common QLEs?

Documentation varies based on the type of QLE. Examples include termination letters, proof of loss of coverage, marriage certificates, legal documents for divorce, birth certificates, proof of new address for residence changes, and income verification for eligibility changes. Refer to the comprehensive list for details.

What if additional documentation is needed for a QLE?

If additional documentation is required, ask the employee to edit their existing QLE submission and attach the necessary files.

Is there a time limit for submitting QLE documentation?

It's crucial to submit documentation promptly, usually within 30-60 days of the qualifying life event, to ensure timely processing of changes to health insurance coverage.

How do I ensure the privacy of employee information during a qualifying life event?

Employers must maintain the privacy and confidentiality of employee information. Implement secure handling practices and keep accurate records to facilitate transparency and compliance.

These FAQs provide general information, and it's crucial to refer to your company's policies for accurate and specific details about QLEs.

We aim to ensure your employees have a positive experience with Fingercheck. To achieve this, we have the article listed below to provide assistance and guidance.


Watch a video showing how to process your employee's QLE, including reviewing documents and notes.

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