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All you need to know about Life Events

In this article, you will find everything you need to know about life events, including what qualifies as a Life Event & how to update your benefits due to a Life Event. 

Life changes are a part of life, and sometimes those big moments—like getting married, having a new baby, or moving to a new city—mean you need to make changes to your benefits coverage.

At GoCo, we call these moments Qualifying Life Events (QLEs), and we make it simple and stress-free to update your benefits right within the platform.
 

This article will guide you through what qualifies as a QLE , how to submit your changes, and how to manage a pending submission.

To skip ahead to any of the following sections, click below.

What is a Qualifying Life Event (QLE)?

A Qualifying Life Event (QLE) is a major change in your life that allows you to make changes to your health benefits outside of the standard annual Open Enrollment period.

There are four main categories of qualifying life events: 

1. Loss of Health Coverage

If you (or a dependent) lose existing health coverage, you are typically eligible to enroll in your employer's policy.

Use Case: Let’s say your child, Alex, is turning 26 this month. Since Alex will lose coverage under your parent's plan, you can request to add them to your GoCo policy immediately after their birthday! 

Examples of Loss of Coverage:

  • Losing existing health coverage, including job-based, individual, and student plans.

  • Losing eligibility for Medicare, Medicaid, or CHIP.

  • Turning 26 and losing coverage through a parent’s plan.

2. Changes in Household

These events focus on changes to your marital or family status.

Event Action 
Having a baby or adopting a child  You're typically eligible to add that child to your insurance coverage. Most carriers will require you to add the child within 30 days of birth or adoption.
Getting married or divorced ou can typically add your spouse, or remove your spouse from your coverage within 30 days of those events
Death in the family  You may need to remove a dependent or change your coverage tier.

3. Changes in Residence

If your address, ZIP code, or state has changed, you may qualify to change your current plan to ensure you are still covered in your new region.

 Use Case: Imagine you are moving from Dallas, Texas, to Seattle, Washington. Your current HMO plan may not cover providers in your new state. A QLE allows you to change your current plan to ensure you are still covered in your new region.
 

Examples of Residence Changes:

  • Moving to a different ZIP code or county.

  • A student moving to or from the place they attend school

  • A seasonal worker moving to or from the place they both live and work.

  • Moving to or from a shelter or other transitional housing.

❗Don't Forget! If your address, ZIP code, or state has changed, you must submit your change request within 30 days of the address change to ensure carrier approval. Be sure to update your address in GoCo as well!

4. Other Qualifying Events (approved by your carrier)

This includes a few other major life moments that allow for a benefit change.

  • Changes in your income that affect the coverage you qualify for.

  • Becoming a U.S. citizen.

  • Leaving incarceration (jail or prison).

  • Gaining membership in a federally recognized tribe or status as an Alaska Native Claims Settlement Act (ANCSA) Corporation shareholder.

  • AmeriCorps members starting or ending their service.

How to Update Coverage due to a QLE (employee experience)

Now that you know what qualifies as a Life Event, you're ready to make changes to your coverage. Follow the steps below to update your coverage to add/remove dependents or enroll/cancel existing benefits. 

  1. Login to GoCo & navigate to your Benefits Module. You can get there by finding the card that reads "Benefits" on your My Profile page. Screen Shot 2022-08-15 at 7.21.06 PM
  2. In your Benefits Module find the blue "Make Changes" button. Screen Shot 2022-08-15 at 7.23.06 PM-1
  3. Select the type of change you would like to make (add dependent, remove dependent, etc.) Please note you will only be able to select options that are available based on your current coverage. Screen Shot 2022-08-15 at 7.24.52 PM
  4. Once you select your reason, you will be taken to the screen below to input details like when coverage should start & adding proof to support your change. Screen Shot 2022-08-15 at 7.28.21 PM
    • ⚠️  Important Tip for "When coverage should start": This isn't just any date; it's the precise day your new benefit coverage will begin or your old coverage will end due to your life event. Here's why this date is so important:

      • It's the True Date of the Event: Unlike typical new hires or open enrollment changes, QLEs have specific rules. For example, if you have a baby, the "Effective Date" for adding your child to your benefits is typically the date of birth. If you get married, it's your marriage date. You need to select the actual, true date that the life event occurred and that the coverage change should be effective from.

      • No Waiting Periods or Termination Rules: This is a key benefit of a QLE! Normally, when you enroll in benefits, there might be a waiting period before your coverage starts, or specific rules for when coverage ends after leaving a job. However, for a Qualifying Life Event, these standard "termination rules" or "waiting periods" do not apply. This means your coverage changes can become effective immediately or very quickly, aligning with the actual date of your life event, as long as you submit the change within the required timeframe (usually 30 days of the event). This only applies if you have already met the waiting period. 

    • ⚠️ Important Tip for Proof: If you don't have your supporting documents (like a marriage certificate or birth certificate) at the exact moment of submission, don't worry! You can upload a random or blank file to bypass this step for now. However, it is crucial that you provide the actual official documents to your HR admin as soon as you receive them. Please be aware that your insurance carrier or broker may request these documents directly.
  5. The next screen is where you will make your coverage changes. Here you can add/remove your dependents information & make your benefits selection choices. Screen Shot 2022-08-15 at 7.30.21 PM
  6. Once you are done making your choices, simply hit the "Finish Enrollment" button. If you would like to leave & come back, you can always hit the "Finish Later" button. Screen Shot 2022-08-15 at 7.37.30 PM
  7. Confirm your submission once more & you'll be taken to this confirmation page. Here you can print for your records. 

Screen Shot 2022-08-15 at 7.40.42 PM

What Happens Next?

  • Depending on your organization's benefits setup, your QLE may need approval from your administrator.

  • Once approved, you will be notified in your GoCo account.

  • Heads Up! An employee can only have one pending QLE at a time.
  • In some cases where you terminate a dependent's coverage, they may be eligible for COBRA or State Continuation. GoCo will prompt you to verify their address so the proper documentation can be sent.

The Crucial Distinction: Switching Plans

What if you're already enrolled in Medical, but your QLE requires you to switch from one existing plan to another within that benefit line (e.g., moving out of an HMO service area and needing to switch to a PPO)?

The Employee Self-Service tool does NOT support switching plans.

  • When you click "Make Changes", the option to "Enroll in New Benefits" will be unavailable because you are technically already enrolled in a plan.

  • This specific action is classified as a Plan Change and must be initiated by your HR administrator.

What to do if you need to switch plans due to a QLE:

  1. Do not try to submit it yourself.

  2. Immediately contact your HR Admin/Manager.

  3. Your administrator will process the change on your behalf via the Admin Tools: Employees Page > Benefits > Life Events > Make Plan Change

How to Edit a Pending QLE

Did you or an employee realize you need to adjust a QLE while it is still processing? No problem! Full-access Admins can quickly make adjustments to a pending Life Event. 

  1. Navigate to the Employees page, then Benefits, and then Life Events

  2. Find the QLE you need to adjust, click the three dots to the right, and select 'Edit'

  3. Make the necessary adjustments, and be sure to click 'Continue' and 'Finish' to officially update the QLE.

Crash Course

For a video training on submitting a life event, see below!

💡 Hit the chapter button on the bottom right of the video, to skip ahead to the Employee POV. 

 

For additional questions, please reach out to support@goco.io

Happy Hiring! 💚