Qualified Life Event | QLE

QUALIFIED LIFE EVENT (QLE) DEFINITIONS

Qualified Life Events (QLEs) include but are not limited to the following:

  • Marital status: marriage, divorce, legal separation, annulment, death of a spouse
  • Dependent status: birth, adoption, placement for adoption, death, marriage or dependent eligibility due to age
  • Eligibility status: becoming eligible for Medicare
  • Residence status: resulting in different plan options available 
  • Employment status or work schedule: affecting benefit eligibility for you, your spouse, and/or dependent. 
    Can include:
    • LWOP - leave without pay 
    • Returning from an Approved Leave: If coverage was modified at the initiation of leave, you must elect your previous level of medical, dental and/or vision coverage. 
      Premiums must be current or you may not re-elect any coverage until the next open enrollment period.
    • Return to Work Retirees - see the information listed below.
  • Additional QLEs - for a full list see the QLE & Mid-Year Changes Chart

NEWBORN COVERAGE - 31 DAY DEADLINE

  • Your newborn is ONLY covered under your insurance for the first 31 days after birth.
  • Before the 31st day, you must ENROLL your newborn as a dependent.
  • Deadline: If you miss the 31-day requirement, your newborn will not have coverage. You will have to wait to enroll until the next Open Enrollment or Qualified Life Event.
  • Note: You do not have to wait for a birth certificate. You may enroll your child with a crib card or hospital verification letter. 
  • Refer to How to Change Benefits for a Qualified Life Event (QLE) below.

 

DUPLICATE/DUAL ENROLLMENT - BOTH SPOUSES STATE EMPLOYEES

Duplicate/dual enrollment in State plans is prohibited and will be terminated with no refunds for the premiums paid. For spouses who are State and/or a State University employees and/or retirees, these rules apply:

  • You cannot enroll each other as dependents, nor have your children enrolled twice.
  • One spouse may elect coverage for the entire family, or each spouse may elect their own individual coverage.
  • Dependent children can be on one spouse's policy or divided between spouses.
  • If your child is a State and/or State University employee, he/she cannot be enrolled as a single subscriber in a State plan and as a dependent on your policy. 
  • You cannot enroll simultaneously as a single subscriber in the retiree medical, dental, and/or vision plans for the Arizona Department of Administration (ADOA) AND the Arizona State Retirement System (ASRS).

TERMINATION OF COVERAGE - CONTINUATION OF BENEFITS

If your benefits are terminated, you may have options to continue coverage:

  • Medical/Dental/Vision 
    • If you experience a loss of coverage due to termination of employment or a QLE, you and or your dependents may extend coverage in accordance with COBRA (Consolidated Omnibus Budget Reconciliation Act). 
    • The Benefits Services Division will determine eligibility.
    • Learn more on our COBRA page. 
  • Life Insurance

WHEN YOU CAN CHANGE YOUR BENEFITS

You may change your benefit elections under the following conditions:

  • Open Enrollment - annually in the fall
  • Qualified Life Event (QLE) - within the deadline listed below
    • The changes you can make are dependent on the type of QLE. See the QLE and Mid-Year Changes Chart for full details.
    • Deadline: All forms and required documentation must be submitted within 31 days of the QLE, as outlined below under How to Change Benefits for a Qualified Life Event (QLE).
    • If you have not experienced a QLE as defined above, you must wait until the next annual open enrollment period to make changes. 
  • Year-Round Benefit Changes
    • Decline Short-Term Disability coverage
    • Decrease Supplemental Life in increments of $5,000 to pre-tax amount of $35K, if applicable
    • Decline Dependent Life
    • Life Insurance beneficiary changes
    • Adjust Health Savings Account (HSA) contributions
    • Adjust Flexible Spending Account contributions - during COVID-19 National Emergency only

HOW TO CHANGE BENEFITS FOR A QUALIFIED LIFE EVENT (QLE)

  1. Gather: All required documentation as listed on the QLE and Mid-Year Changes Chart
  2. Fill out: Declaration for Change Form 
  3. Fill out: Active Benefits Enrollment Form - 2021
  4. Deadline: Submit both forms WITH required documentation within 31 days of the QLE. 
  • Any missing information or supporting documents will delay processing, see below
  • Email: [email protected]
  • FAX: 602-542-4744

SUPPORTING DOCUMENTATION REQUIREMENTS

  • Supporting documentation must be provided when adding/removing a spouse or dependent. 
  • See the QLE and Mid-Year Changes Chart for the documents required.
    • Note: You do not need a birth certificate to enroll a newborn. You may use a crib card or hospital verification letter. See "Newborn Coverage" above.
  • Deadline: All forms and required documentation must be submitted within 31 days, or loss of enrollment will result.