Qualifying Life Event (QLE) is a change in an employee’s status like getting married, having a baby, or losing health coverage that can make him/her eligible for a Special Enrollment Period, allowing enrollment in health insurance outside the yearly Open Enrollment Period.
This platform allows you to manage QLE or Life Status Change (LSC) for your clients and employees where you can add any LSC on the employee’s behalf and complete the enrollment. The system provides an opportunity to change plan elections through Life status changes in the middle of the year.
Note: You can add LSC event only when the employee has been enrolled and the coverage is effective.
Follow these steps to add a life status change for an employee:
1. Log in to the applicable portal (broker or employer).
2. Search for the employer (client) for whom you want to make changes.
3. Click the Manage Employees tile under Core Operations.
4. Click the Manage Life Status Change Event(s) icon under Actions for the employee you want to add changes for.
5. Select the LSC event applicable to the employee. The LSCs available in the system are:
- Address Change
- Marriage
- Birth/Adoption/Guardianship of child
- Class Change
- Coverage Maintenance
- Divorce
- Employee loses other coverage
- Loss of Medicare
- Loss of Medicaid or SCHIP
- Employee gains other coverage
- Dependent gains other coverage
- Medicare Eligible
- Medicaid or SCHIP eligible
- Dependent ineligible due to age
- Death of covered dependent
- Court Order
Note: (For Employees) You will not be able to see Address Change, Class Change, and Coverage Maintenance events on your portal.
Example: Birth/Adoption/Guardianship of child is selected in the screen below to add birth event of a child.
2. Add the Event Date and you will see that changes will be effective from the same date. The details of applicants are listed. You can add details of a dependent also using the link on the page.
3. Click the Initiate Change button to continue the workflow.
A pop-up appears with the following options:
- If you click the Initiate Change button, you land on the Employees page where you can impersonate the employee using the respective icon under Actions and complete the workflow, or the employer/employee can complete the procedure after you (Broker) initiate the change.
- If you click Complete Enrollment button, the employee page opens where you complete the workflow acting on employee’s behalf.
8. Click the Continue button to complete the enrollment for LSC.
You will see the following details:
9. Click Continue. A pop-up appears. Click Yes, I want to report an event.
You will see the details of who is covered in the plans.
10. Click Continue and add details of the dependent (the screen example shows new born Ben’s details are added)
11. Click Continue and review the information.
12. Click Continue and confirm the changes.
13. Click Continue to add the plans.
You have the option of creating your health plan or choose from the offered plans.
- Create Your Own Health Profile: If you click the option, you are run through a series of questions that help you find the best plan based on your inputs.
Finally, after answering the questions in each category (Potential expenses, Ongoing care, Expected usage, Plan preferences), you can see a summary of your inputs. Click the See Benefits button to see the details. Add the desired plan and checkout.
Note: You can use the Back arrow to go back to any step.
- Show Me Medical Plans: If you click this option, you will directly see the plans.
14. Select the plans as desired and click the Continue Enrollment
15. Click Continue to checkout and complete the process.
16. Verify all the details as these are shared with the insurance companies.
17. Click the Save & Continue button to verify the spouse and dependent(s) details.
18. Add the doctor’s details to the dependent (In this case add details for the new born Ben, the newly added dependent)
19. Save & Continue to confirm if you have any other insurance policy, so that your insurance company can coordinate benefit claim payments with your other insurance plans.
20. Save & Continue to open the Terms and Conditions page.
21. Add the signature (first and last name) on behalf of the employee and add your signature.
22. Click the Submit Application
A pop-up appears giving you the option of notifying the employee.
23. Click Yes or No to submit the enrollment. A congratulations message will appear when the enrollment has been submitted successfully.
24. Click the Benefits Dashboard button to see the change on the dashboard.
Note: You can add another LSC after successfully completing the current LSC event by clicking Report a Change button on the dashboard. You cannot add an event if your plan has a future effective date or you have a pending event.
