Normally, you can only modify your insurance coverage when you are a new hire, become newly eligible, or during your company's annual open enrollment. However, there is an exception known as a Qualifying Life Event (QLE). A QLE is an event considered valid by your insurance carrier that allows you to change your benefits outside of the open enrollment period.
Remember to submit your QLE request and provide valid proof of the event to Niural within 30 days from the date the life event occurred. Carriers take 1-3 weeks to review the requested changes. If your request gets approved, the carrier will decide the effective date of the change, and we'll update your benefit details in Niural accordingly.
Qualifying life events that may apply to you or your dependents include:
- Gaining or losing other health 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 affects your benefits eligibility
- Aging out of dependent coverage (age eligibility varies by state)
It's important to note that voluntary drop or cancellation of coverage does not qualify as a special enrollment or qualifying life event. Only involuntary loss of coverage counts as a qualifying life event. Decisions about qualifying life events are determined by your insurance carrier. If an event you experienced is not on this list, you will need to wait for your company's annual open enrollment for making changes to your benefits.
Qualifying Life Events (QLE) and Eligible Changes
Updates you can make with a Qualifying Life Event (QLE):
- Enroll in coverage
- Cancel coverage
- Add or remove dependent(s) from coverage
- Change your plan
Qualifying life events necessitate supporting documentation for insurance carriers to approve changes. You must submit valid proof through Nirual within 30 days of the event. The proof should include the full names of the affected employee and each dependent, along with the date of the event.
Here's a list of common qualifying life events and the documentation required for each:
QLE |
What you can change |
Documentations you can submit |
Birth or adoption |
- Make Enrollment or Coverage Changes for Yourself and/or New Dependents
- Include the Newborn in the Coverage Addition or Plan Change Request
|
- Birth certificate
- Hospital record of birth
- Adoption letter or record
|
Marriage |
- Sign Up for New Coverage for you or your Spouse
- Add spouse and/or new dependents to a coverage
|
- Marriage certificate (from city clerk’s office)
|
Marriage |
- Drop coverage for yourself or any dependents when switching to spouse's plan
|
- Proof from the new insurance carrier with your name and the coverage start date
|
Domestic partnership |
- Enroll in new coverage for you and your partner
- Add your domestic partner to coverage
|
- Certificate of domestic partnership
|
Domestic partnership |
- Drop coverage for yourself and any dependents
|
- Proof from the new insurance carrier with your name, any dependents' names, and the coverage start date
|
Divorce or legal separation |
- Enroll in coverage for myself
- Add dependents to coverage
|
- Letter of cancellation from your previous carrier with the end date of coverage for you and each affected dependent
- Divorce decree
|
Divorce or legal separation |
- Remove spouse and/or dependents from coverage
|
- Divorce decree
- Proof from spouse or dependent's new insurance carrier with their name and new coverage start date
|
Court order to cover dependents |
- Enroll self and dependent(s) in coverage
|
- Copy of the court order including the employee and dependent names, and date of the order
|
Aging out of parent’s coverage |
|
- Letter of cancellation from your previous carrier with your name and the end date of coverage
|
You gained other coverage |
- Cancel coverage for you and your dependents
|
- Proof from the new insurance carrier with your name and the new coverage start date
|
Dependent gained other coverage |
- Cancel coverage for your dependent(s)
|
Proof from the insurance carrier with the new coverage start date and the name of the dependent. Each dependent must have proof of other coverage
|
You lost other coverage |
- Enroll in coverage for myself and dependents
|
- Letter of cancellation from your previous carrier with your name, and dependents' names, and the end date of coverage
- Employer letter on company letterhead with your name, any dependents' names, and the end date of coverage
|
Dependent lost other coverage |
- Enroll dependent in coverage
- Change plans to support added dependent(s)
|
- Letter of cancellation from your previous carrier with the dependents' names and end date of coverage. Each new dependent must have proof of canceled coverage
- Employer letter on company letterhead with the dependents' names and the end date of coverage
|
Moved in or out of plan area |
- Cancel coverage if you or a dependent have moved out of the service area and become ineligible for coverage due to the move
- Add or change coverage if you or your dependent has become eligible for coverage due to a move
|
- USPS change of address confirmation with date
- Bills for financial statements showing a change of address and recent date
- Documentation for mortgage or rent showing new address with a move-in date
|
International relocation |
- Cancel coverage if you or a dependent have moved to another country
- Add or change coverage if you or your dependent have moved to the U.S. from another country
|
- An Arrival or Departure Record (I-94) with the affected individual's full name and date of entry or departure
- A passport stamped with the recent entry date
|
Death of a dependent |
- Cancel coverage for the dependent
|
|