Qualifying Life Events (QLE)

 

You may add, change, or cancel coverage during the plan year if you have a qualifying life event.

Qualifying life events are those situations that cause a change in your life that has an effect on your health insurance options or requirements.  The IRS states that a qualifying event must have an impact on your insurance needs or change what health insurance plans that you qualify for.  In either case, the qualifying life event would trigger a special enrollment period that would make you eligible to make changes to your benefit elections.

If you have experienced one of the qualifying life events listed below or are unsure if your circumstance qualifies for a special enrollment, contact the KISD Benefits Department at benefits@kleinisd.net for more information or to make changes to your benefits. All changes to your own or a dependent’s coverage must be made within 30 calendar days after the qualifying life event. You are responsible for meeting this deadline. If you do not request the appropriate changes during the applicable special enrollment period, you cannot make changes until the next plan enrollment period or, if applicable, until another qualifying life event occurs. Benefit adjustments resulting from a qualifying life event take effect on the first day of the month following the event date, with the exception of birth, adoption, and court orders.

Please complete this form when requesting mid-year changes.

Examples of such events include, but are not limited to:

  • Death of spouse or other dependent

  • Marriage or divorce

  • Birth, adoption, or placement for adoption of a child

  • Change of employment status of you, your spouse or dependent

  • The termination, other than by reason of such employee’s gross misconduct, or reduction of hours, of the covered employee’s employment

  • The covered employee becoming entitled to benefits under Medicare

  • A dependent’s loss of eligibility (attainment of limiting age or change in student status). However, you may not change plans if you are dropping a dependent from your coverage

  • Involuntary loss of coverage for a person with other health insurance coverage (for example, your spouse loses health coverage at work)

Note: If you enroll/make changes during the year due to “loss of other coverage,” your original Enrollment Application and/or Change Form will be checked to verify that coverage with Klein ISD was declined due to the other coverage.

Special Enrollment Period

A special enrollment period is a set period in which you would be allowed to enroll or change your health insurance coverage.  Apart from a current employee transitioning into full-time status, any enrollment decision you make, including the decision not to enroll, stays in effect for the entire plan year.  You may only make changes during the year if you have a Qualifying Life Event.