What is a Qualifying Life Event?

The following are examples of common qualifying life events (QLEs) that allow eligible workers to enroll or make changes to their coverage, including adding dependents, outside of their company's Open Enrollment period.

This page contains the most common examples of QLEs. This is not intended to be an exhaustive list, and does not contain examples for every available QLE situation.

Some qualifying life events also act like open enrollment for the whole family. For example, if an employee that is not enrolled in benefits has a baby, the employee can enroll themselves, their spouse, and all eligible dependents as well. Eligible dependents can take advantage of a qualifying life event to modify or elect new coverage. They can also cancel their plan coverage if a qualifying life event occurs.

Having a baby or adopting a child

If an eligible worker has a baby or adopts a child, they can usually add their child to their insurance policy within 30  days of birth. To allow for processing time, this must be completed in Zenefits within 27 days. The effective date for the child's coverage may vary by carrier. For information on your rights as a new mother, read here.

Getting married or divorced

If an eligible worker gets married, they can usually add their spouse to their insurance policy within 30 days of the marriage date. This must be completed in Zenefits within 27 days to allow for processing time. If they lose coverage through divorce, they can enroll within 30 days of the divorce finalization date. This must be completed in Zenefits within 27 days to allow for processing time.

 

A dependent losing coverage due to turning 26

If a child leaves the plan due to "aging out" at age 26, the eligible worker can change their coverage accordingly. This is a loss of coverage QLE and the effective date for coverage will be backdated to the date that the coverage officially terminated.
Example: An employee has their 26th birthday on September 27th, however the coverage remains active through the end of September. The coverage cancels on September 30th, and employee can enroll in their employer's group coverage within 27  days for an October 1st effective date.

Change in employment status

If the worker, spouse, or dependent changes employment status that affects health insurance eligibility. This includes: 
- Being hired (keep in mind that if you are a new hire, you may have to satisfy a waiting period)
- Quitting a job or being laid off.
- Moving from part-time to full time.
This is a loss of coverage QLE and the effective date for coverage will be backdated to the date that the coverage officially terminated.

Moving to the USA

If an eligible worker and their dependent(s) move into the US from outside of the country, they are able to join a plan under a QLE if they can show their passport stamp within 30 days of arrival. This must be completed within 27 days in the Zenefits system to allow for processing time.

Loss of a dependent

If a dependent passes away.

Spouse Open Enrollment

A spouse going through open enrollment counts as a qualifying life event. For example, if a spouse chooses to decline coverage through their company's open enrollment, they can be added as a dependent to the employee's plan in Zenefits.

Declining Marketplace Insurance

Declining individual marketplace open enrollment coverage is considered a qualifying life event to enroll in company coverage by many carriers. Please contact your insurance carrier for final confirmation on whether it is considered a QLE.


If you are a worker experiencing a qualifying life event, follow these instructions to update your benefits coverage.

If you are an administrator making a change on behalf of one of your employees, please connect with your broker to update Zenefits.

If you are the broker or the broker administrator making an update on behalf of a worker, follow these instructions to update your worker's benefits coverage.

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