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.

For example, ensuring that all children on an employee’s health plan are under age 26. This process requires employees to provide documentation to validate the relationship between the employee and the dependent.

Dependent verification presents a multitude of challenges for employers. First, it’s difficult to track when a dependent should come off an employee’s plan, such as when a child turns 26 or an employee divorces their spouse. Many plan participants are unaware of what they are doing and don’t know or understand their plan’s dependent eligibility rules. If dependent information is not properly tracked, dependents could be on an employee’s plan when they shouldn’t be, costing the employer unnecessary dollars on benefits coverage and increasing risk of compliance penalties—especially for self-insured employers. While many HR teams might run a regular (i.e., annual or bi-annual) review of this information, the process is time-consuming, requires a lot of “back and forth” exchanging of documentation and pulls HR away from other business priorities.

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 benefits both employees and employers in a multitude of ways 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.