A qualifying life event (QLE) is a term defined by OPM to describe events deemed acceptable by the IRS that may allow participants in cafeteria plans (including premium conversion) to change their participation election for premium conversion outside of an open season.�

With two exceptions, the rules for changing FEHB enrollment outside of Open Season do not change. Most of the time, people make changes to their FEHB enrollment on account of and consistent with a qualifying life event.� The opportunities for you to enroll or change enrollment described in 5 CFR Part 890, and described in the FEHB Employee Health Benefits Election Form (SF 2809) will continue to be allowed under premium conversion except:

• you may not cancel your enrollment at any time
• you may not change from self-and-family to self-only at any time.

You will still be allowed to make these changes to your enrollment if the change is on account of and consistent with a qualifying life event.

The IRS has additional events that will allow you to change your participation (election) in premium conversion.�� Read on for more information.

Under OPM's premium conversion plan, the qualifying life events that may allow you to change your premium conversion election are:

• Changes in entitlement to Medicare or Medicaid for you, your spouse or dependent
  • Your Spouse or dependent first becomes eligible for coverage under Medicare or Medicaid
  • You, your Spouse or dependent loses entitlement to Medicare or Medicaid

• Employment Status
  • Change in your employment status or that of your spouse or dependent from either full-time to part-time, or the reverse
  • Start of your spouse's employment
  • Your Spouse or dependent is employed in a position that offers health insurance
  • Start or end of an unpaid leave of absence by you, your spouse or your dependent

• Other
  • Significant change in the cost or conditions of your spouse's health care coverage related to your spouse's employment that affects you.

If you are not participating in Premium Conversion, you may elect to reduce your FEHB coverage at any time.�As a participant in premium conversion you will be able to reduce FEHB coverage only during an FEHB Open Season or in conjunction with a QLE. IRS rules govern these non-Open Season opportunities for those who participate in premium conversion. �

Mary J. is a single parent with one dependent, who will turn age 22 at the end of March.� She wants to maintain her self-and-family coverage until that time.� The loss of a qualified dependent is a QLE, and changing her coverage from self-and-family to self-only is on account of and consistent with that QLE.� At the end of March, Mary changes her coverage to self-only.�

Michael M., a federal employee, has self-only coverage and so does his wife, who is employed in the private sector.� In June, she gives birth to their first child.� Michael wants to cancel his FEHB coverage, saying that his wife has picked up family coverage that includes him and their new child.�� Michael's request is on account of and consistent with his QLE.�

Monique K. begins an approved period of LWOP to attend school.� She elects to keep her FEHB coverage, and incur an obligation to her employing agency.� She may not change her FEHB coverage, but may change her premium conversion election. �

Agencies must determine acceptable documentation for QLEs.� Acceptable documentation includes birth and death certificates, marriage licenses, divorce papers, etc.� When your QLE is one where documentation is not readily available the IRS has indicated that your certification of coverage under another health plan is sufficient.