Do Your Employees Know What to Do When They Have Qualifying Events?

When an employee experiences a life event such as the birth or adoption of a baby or a marriage, chances are they’re not immediately thinking about how it impacts their insurance. However, many qualifying life events warrant different insurance choices and shouldn’t be forgotten. Read on for what qualifying events are and how HR should handle benefits administration when employees encounter qualifying life events.

What is a Qualifying Event?

A qualifying life event is any change to an individual’s circumstances that allows them to make adjustments to their benefits despite the time of the year. These include losses in health coverage, changes in the household, changes in residence, and others.

Typically, employees are only eligible to make adjustments during the company’s open enrollment period, which often (but not always) takes place towards the end of the year.

What is HR’s Responsibility When Employees Have Qualifying Events?

It’s imperative that employers have the appropriate processes in place to properly administer benefits when an employee has a qualifying life event. HR can communicate the process to employees when they’re onboarding, but having the steps spelled out in a Culture Guide is even more helpful so that employees can reference the information whenever qualifying life events happen.

Are employees expected to reach out to HR first when they encounter a qualifying life event? Or does HR keep track and reach out to remind employees to make adjustments to their benefits? It’s important for everyone to be on the same page so that electing benefits during a qualifying event isn’t overlooked—especially since the consequences can mean that an employee or family member is without insurance.

Utilizing a human resources information system (HRIS) is key to staying organized. A robust platform like BerniePortal empowers HR managers to keep track of appropriate employment documents—such as W-4s, I-9s, and other new hire information—and helps keep you compliant with legal standards and regulations.

Not only that, but an HRIS empowers current employees to be able to make their own changes without assistance needed from HR managers. By presenting benefits options on a single, intuitive system, you’re making everyone’s lives easier. This is more convenient for each person involved, and you’ll have more time on your hands to help shape the culture of your team.

What Counts as a Qualifying Life Event?

According to the Federal government, there are four primary types of qualifying events:

  • Loss of health coverage: This can include job-based and individual coverage, as well as student health plans. Typically these events occur when a person is laid off, fired, their company/organization shuts down operations, or the person leaves college. Other instances include losing eligibility for Medicare, Medicaid, or CHIP, and when a person loses coverage through a parent’s plan after turning 26.

  • Changes in household: Examples include getting married or divorced, having a baby or adopting a child, and a death in the family.

  • Changes in residence: Examples include when someone moves to a different ZIP code or county, when a student moves to or from the place where they attend school, a seasonal worker moving to or from the place they both live and work, and someone moving to or from a shelter or other transitional housing.

  • Other qualifying events: Other types of events can include changes in a person’s income that impact the coverage they qualify for, gaining membership in a federally recognized tribe or status as an Alaska Native Claims Settlement Act (ANCSA), becoming a U.S. citizen, leaving incarceration, and when AmeriCorps members begin or end their service.

Source: Bernie Portal

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