Summary
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Your insurance coverage can usually be changed during your new hire enrollment, as a newly eligible employee, or during your company’s annual open enrollment. A Qualifying Life Event (QLE) is an exception that allows changes outside of these periods, such as getting married or a dependent gaining coverage through a new job.
You have 30 days from the date of the event to submit your QLE and valid proof in Gusto. You cannot submit a change before the event occurs.
If your request is approved, your insurance carrier determines the effective date of the change. If the QLE is submitted on time and accepted by the carrier, most carriers backdate the effective date of the change to the date of the event. Once approved, we’ll update your benefit details in Gusto.
Are you enrolling as a new hire or during open enrollment? Check out our Enroll in or waive benefits article.
The federal law defines qualifying Life Events. HIPAA provides special enrollment periods for employees and dependents due to loss of eligibility and specific qualifying life events. Additionally, HIPAA prohibits discrimination based on any health factors they may have, including prior medical conditions, previous claims experience, and genetic information. For more information, read these FAQs on HIPAA Portability and Nondiscrimination Requirements for Workers.
A voluntary drop or cancellation of coverage does not qualify for a special enrollment or QLE. Canceling a plan or failing to pay the premium are considered voluntary coverage losses and not qualifying life events.
Whether a life event counts as a qualifying one is ultimately up to your insurance carrier. If an event you experienced is not on this list, your next chance to make changes is at your company’s annual open enrollment.
Qualifying life events that you or your dependents may experience:
- Gaining other coverage
- Losing other coverage involuntarily (including COBRA or continuation coverage)
- Marriage or domestic partnership
- Divorce or legal separation
- Birth or adoption of a child
- Placement of a foster child
- Death of a spouse or child
- Court-ordered mandate to cover a dependent
- Moving in or out of a service plan area
- Moving to or from another country
- Aging out of dependent coverage
- Gaining U.S. citizenship
Changes 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 and required documents
To approve changes, insurance carriers require proof of a qualifying life event and timely submission of your request. You must submit valid proof in Gusto within 30 days of the event. It must include the full name of the affected employee, each affected dependent, and the date of the event. If your life event is not submitted on time, Gusto reserves the right to deny your life event changes.
Whether a life event counts as a qualifying one is ultimately up to your insurance carrier. Here’s a list of common qualifying life events, the changes you can make, and commonly accepted documentation required for each:
| Birth or adoption | ||
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| Changes you can make | Commonly accepted documents | Information required on documents |
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| Marriage | ||
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| Changes you can make | Commonly accepted documents | Information required on documents |
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| Divorce or legal separation | ||
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| Changes you can make | Commonly accepted documents | Information required on documents |
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| Court order to cover dependents | ||
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| Changes you can make | Commonly accepted documents | Information required on documents |
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| Aging out of parent’s coverage | ||
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| Changes you can make | Commonly accepted documents | Information required on documents |
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| You gained other coverage | ||
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| Changes you can make | Commonly accepted documents | Information required on documents |
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| Dependent gained other coverage | ||
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| Changes you can make | Commonly accepted documents | Information required on documents |
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| You lost other coverage | ||
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| Changes you can make | Commonly accepted documents | Information required on documents |
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| Dependent lost other coverage | ||
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| Changes you can make | Commonly accepted documents | Information required on documents |
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| Relocation (Must have moved in or out of HMO plan area to be eligible) | ||
|---|---|---|
| Changes you can make | Commonly accepted documents | Information required on documents |
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| International relocation | ||
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| Changes you can make | Commonly accepted documents | Information required on documents |
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| Death of an employee | ||
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| Changes you can make | Commonly accepted documents | Information required on documents |
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| Death of a dependent | ||
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| Changes you can make | Commonly accepted documents | Information required on documents |
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| Gaining U.S. citizenship | ||
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| Changes you can make | Commonly accepted documents | Information required on documents |
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If your company offers benefits through Gusto (including the broker integration), you can change these benefits in your employee account. If your company offers benefits through another broker, contact your broker to make changes.
You must provide dated proof of the event to submit a qualifying life event (QLE) and change your or your dependents’ coverage.
This documentation must include:
- The date of the event
- The full names of the affected individuals
- The type of coverage affected
- How it relates to the enrollment change you’re making
Here are examples of proof for each type of qualifying life event:
You or a dependent gained other coverage:
- Screenshot from your member portal with the carrier name, full name of individuals covered, effective start date, and type of coverage
- Letter from the carrier with the carrier name, full name of individuals covered, effective start date, and type of coverage
- You can also call your new insurance company’s Member Services Department and ask that “proof of creditable coverage” be faxed or emailed to you
You or a dependent lost other coverage:
- Screenshot of your member portal with the name of the previous carrier and the last date of coverage
- A letter from the carrier with the name of the previous carrier and the last date of coverage
- You can also call your old insurance company’s Member Services Department and ask that “proof of creditable coverage” be faxed or emailed to you
There was a change in your household:
- Birth certificate or adoption papers with the dependent’s full name and date of birth or adoption
- Marriage license or Domestic Partnership with the full name of each individual and the date of marriage or partnership
- Divorce or legal separation papers with a finalized divorce decree or loss/gain of other coverage
- Death certificate
You or a dependent moved residences:
- Change of address notice from the USPS
- A utility bill with your name and address
Some carriers may not allow screenshots as proof of coverage, and the specific required documentation differs across carriers. Depending on the carrier, Gusto may contact you for further documentation.
To report your qualifying life event in Gusto, follow the steps below.
- Sign in to your Gusto employee account.
- Go to the Benefits section.
- If you have active benefits, click Any major life changes? Update your benefits.
- If you do not have active benefits, scroll to the Health & Life section and click Add Coverage.
- If you do not see either of these options, contact your company’s benefits team for assistance.
- On the Change your Benefits page, click the drop-down menu to let us know the reason for changing your benefits.
- A second drop-down menu will appear based on your reason for changing your benefits. Select the detail that applies to you.
- Enter the date of the event.
- To upload documentation of the event, click Upload and select your QLE proof.
- Click Continue.
- For files over 8 MB, this may take 1 minute to process.
The next page returns you to your benefits dashboard to continue making your change.
To review your personal details and dependent information, follow the steps below.
- On the Benefits dashboard, find the yellow sticky note labeled Time-Sensitive Benefit Enrollments, then click Enroll or waive.
- On the page that opens, click Get Started!
- Review your personal details. If you need to make changes, check out our Edit bank and personal information article for help.
To review your dependents, scroll to Your dependents. Any dependents who have aged out of eligibility for coverage are listed under Ineligible for coverage.
To add a dependent:
- On the Add a new dependent tile, click Add dependent.
- Fill out their personal information.
- Click Save & continue.
To remove a dependent:
- Under Your dependents, find the dependent you’re removing and click Edit.
- Click Remove dependent.
- Note: If this does not work, proceed to the next page, where you can un-enroll the dependent from coverage.
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- Click Remove.
- Click Save & continue.
The next page lists each type of coverage your company offers. This is where you’ll make the change that corresponds with your QLE.
To review a plan’s Summary of Benefits (SBC), click View full plan details. The SBC can help you understand the costs of common covered services. For more information, check out our Guide to your medical benefits.
For each line of coverage you want to change, click Enroll or waive.
- You can make any of the following changes:
- Add dependents: For each dependent you’d like to add, click the checkbox next to their name. If you’d like to add a dependent that is not listed, click Add Dependent. Then, scroll down and click Add dependent to fill out their information.
- Remove dependents: For each dependent you’d like to remove, click the checkbox next to their name.
- Choose a plan: Find the plan you want and click Select.
- Cancel coverage: Scroll to the Waive Medical Coverage tile and click Waive.
- After making your changes, click Save & continue.
- Repeat for each line of coverage.
- Answer the questions on the Add Extra Info page that opens.
- If you’re waiving coverage, the carrier needs the reason for waiving to verify that your company meets their participation requirements.
- Click Save & continue.
To complete your benefit enrollment, follow the steps below.
- Review each line of coverage to make sure your new enrollment details are correct.
- To make a correction, scroll to the bottom of the page and click Back.
- Scroll to Forms you need to sign.
- To review a form, click on its name to open it in a new tab.
- Click Sign form beside each form.
- Draw your name in the signature field and click the agreement checkbox.
- Click Sign.
- Once you’ve signed each form, click Confirm Enrollment.
Submission to the carrier
If Gusto is your broker, we’ll prepare the paperwork and send your selections to the health insurance carrier. If your company uses the broker integration, we’ll notify your broker to submit your selections to the health insurance carrier. Most insurance carriers take 1–3 weeks to review requested changes.Enrollment status
You can check your enrollment status using the sticky note in your Benefits section.Member ID and accessing care
Once the carrier processes your coverage, they’ll mail you your member ID card. If you need to visit the doctor before your ID card arrives, check out our article on finding your health insurance member ID.Adjusting payroll deductions
If the insurance carrier approves your QLE after your company has already run payroll for that time period, your paycheck might not yet reflect updated deductions. We’ll email your benefits admin if anything needs to be adjusted and what to do next.
If you’ve experienced a qualifying life event that allows you to cancel your insurance plan, here’s how to request your cancellation in Gusto.
- Sign in to your Gusto employee account.
- Head to the Benefits section.
- Click Any major life changes? Update your benefits.
- Select I need to cancel my coverage.
- Choose the reason for changing your benefits.
- Enter the date of the event.
- Upload documentation of the event.
- Click Continue.
- Select each line of coverage you want to cancel.
- Flexible Spending Account (FSA): You cannot cancel an FSA mid-year but you may be eligible to decrease your contribution. If you indicate that you want to change your FSA, we’ll contact you to confirm what changes you’re eligible to make.
- Short-term disability, long-term disability, and life insurance: These plans cannot be waived because your company pays 100% of the premiums. The insurance carrier automatically enrolls all eligible employees in these plans.
- Click Continue.
- Review your benefits, then click Looks good to confirm your changes.
- Click Sign form and enter your signature.
- Once each form is signed, click Confirm cancellation.
We’ll submit your request to the insurance carriers and let you know if they require any other information.
Your insurance carrier will determine your last day of coverage. It is typically the last day of the month when the QLE occurred. Once the carrier confirms, your Gusto account will include the last day of coverage.
If an employee of your company receives a court order to enroll their dependents in health insurance, the primary administrator of your company will receive a National Medical Support Notice (NMSN). A local support agency sends this to make sure that children receive health care coverage when it’s available and required as part of a child support order.
Next steps
If health benefits are available to the employee, they should add the dependents to their coverage. A court order counts as a qualifying life event, meaning the employee can enroll themselves and their dependents outside open enrollment.
How to enroll
If you offer benefits through Gusto, including the broker integration:
- The employee should enroll the dependent from their Gusto account within 30 days of the date on the order—follow the steps above under Change your benefits in Gusto. When prompted, upload a copy of the court order.
- If the employee does not take action to comply with the court order in time, the employer may reach out to Gusto, and we’ll help to enroll them.
If you offer benefits outside of Gusto:
- Work with your broker to enroll the employee’s dependents.
- If you need to collect contributions from the employee, you can set up a benefit deduction to collect any employee contributions and report company contributions.
- If the employee does not take action to comply with the court order in time, contact your broker for the next steps on complying with the order.