Federally-Approved Qualifying Events
You may have heard the term “federally-approved qualifying event” when making changes to your health benefits outside the open enrollment window.
Here’s a quick rundown of what that means.
Any tax-free employee benefits fall under Section 125 of the IRS code. Because the IRS regulates these benefits, employees are only permitted to enroll in, change, or terminate coverage within 30 days of initial eligibility for benefits, during designated annual open enrollment periods, or within 30 days of federally-approved qualifying events.
Qualifying events are circumstances that may cause an employee or their immediate family members to become eligible to enroll in, change, or terminate coverage in the company’s plan. The employee must make their benefit elections within 30 days of these life changes.
Qualifying events include
- Job hire or termination
- Birth or adoption of a child
- Marriage or divorce
- Reduction of hours from full-time to part-time
- Increase in hours from part-time to full-time
- Losing existing health coverage, including job-based, individual, and student plans
- Losing eligibility for Medicare, Medicaid, or CHIP
- Gaining eligibility for another plan, such as a spouse’s coverage
- Change in a child’s dependent status
- Turning 26 and losing coverage through a parent’s plan
- Death in the family
- Becoming a US citizen
- Leaving incarceration (jail or prison)
With most benefit plans, changes must align with the event. For example, a spouse’s job loss can create an event in which the spouse may be qualified to join the employee’s benefit plan.
We’re here to help! For questions regarding a federally-approved qualifying event, please contact Nextep’s benefits department or your Health Advocate.
