What is a QLE?
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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.
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What are the additional QLEs?
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Under OPM's premium conversion
plan, the qualifying life events (QLEs) 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.
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What is the difference between a QLE and FEHB's Opportunities to Change
Enrollment?
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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 qualifying life event (QLE). IRS rules govern these non-Open Season
opportunities for those who participate in premium conversion.
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What are some
examples of QLEs that meet the "on account of and consistent with"
criteria?
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Mary J. is a single
parent with one dependent, who will turn age 26 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 a qualifying life event (QLE). 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.
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