Qualified Life Events
Getting married or divorced? Having a baby? Did your spouse gain family medical coverage at his/her job? You're in luck! Benefits eligible caregivers may be able to change their health and welfare elections mid-year with a qualified life event. See details below:
1. What is a qualified life event?
Each year during November, you are given an opportunity to elect benefits for the following calendar year. The period during which you can make this election is called an “open enrollment period.” Once you make your elections, they generally are irrevocable for the following calendar year.
A qualified life event (QLE) is an event that may allow you to make certain changes to your Intermountain Health benefits outside of the regular open enrollment period. A QLE is a change in your status like getting married or the birth of a new baby that allows you to make benefit changes for a limited period of time after that event.
2. What are examples of qualified life events?
Examples of QLEs include gaining/losing a spouse through marriage, divorce, or death, and gaining a new dependent (this includes having new baby or adopting a child). You can also make certain changes to your benefits if you go on unpaid leave, if your employment with Intermountain Health changes, if one of your dependent’s employment changes, or if a dependent loses/gains coverage elsewhere. You may review the Intermountain Health flexible benefit plan for more information about QLEs.
3. How long do I have to notify Intermountain Health of my change in status?
Generally, life events must be submitted through Oracle within 31 days of the event. For newborn babies or newly adopted children, you have 60 days from birth or adoption to submit your request. If you miss these deadlines, you cannot make a change till the next open enrollment period.
4. What changes can I make to my benefits in a QLE?
It depends. Your election change must be consistent with the event and with IRS regulations governing mid-year election changes. For example, if your child turns 26 and drops from insurance, this does not mean you can increase spouse life insurance, but you may be able to decrease how much you put into a medical FSA since you are now covering one less dependent.
5. When will the coverage change take effect?
The type of even typically determines when the change in coverage will occur.
|Event||QLE Paperwork Due
||Coverage Effective Date
|Adding newborn or a newly adopted child||Within 60 Calendar days of Birth or Placement||Coverage change effective on the child’s date of birth or placement of adoption|
|Adding a new spouse||Within 31 days of gain spouse||Coverage change is effective first of the month following marriage|
|Gaining other coverage||Within 31 days of other coverage gain||Coverage change is effective first of the month following the change|
|Dependent Child turns 26||SCL Health will transition children over 26 to COBRA.||Children are covered on medical, dental, and vision through the end of the month in which they turn 26, unless they are disabled.|
|A change in cost or coverage||Within 31 days of cost change||New election is effective the first of the month following the cost change|
6. Do I need to submit any documentation for my QLE?
You will need to submit your event through Oracle. You may be required to submit supporting documentation for certain events, as well. If you are adding dependents to coverage, you also will have to verify their eligibility with HMS. They will send you a letter and follow up with emails to submit that documentation. To review which documents you can submit, visit The Landing, associate resources, benefits, and dependent eligibility verification.
7. Where do I go to submit my life event?
Contact Ask HR M-F 7:30 – 5:00 at 855-412-3701 or via email Peaks_SOemail@example.com. Do not contact the insurance carriers directly to report your QLE, they are not able to change coverage and will not report your change to Intermountain Health.
Changing your status in Oracle will not start the life event process (i.e. changing your marital status to single from married, or changing your LDA to spouse).
8. I have a QLE and I want to just change one benefit (add my new spouse to dental, but nothing else), can I do that?
Yes. You do not need to make changes to all your benefits if you have a QLE. In Oracle, you can specify which benefits you would like to change. If you only need dental insurance for your new spouse, you can add your spouse to dental only, and not medical or vision.
9. I am not currently covered but I had a baby and need coverage now, do I need to be on the insurance too in order to cover my child?
Yes, you also need to be covered in order to have dependents covered. When you begin the life event process, you will be added to the insurance if you were not previously covered.
10. I don’t think that I have a QLE, but I have changed my mind about the benefits that I picked at open enrollment, can I make changes mid-year?
No, you cannot make changes to your benefits within the plan year without a QLE. You will need to wait until next open enrollment to make benefit changes.
11.Where should I go to learn more?
The benefits site on The Landing is a great place to start. Click on The Hub link on The Landing to submit your questions to Ask HR. You can also speak with an Ask HR representative from 7:30 a.m. to 5 p.m. MT by phone at 855-412-3701.