What You Need to Know About QLEs & How You Can Use Technology to Streamline Your Agency’s Processes
Most people enroll or change their plans during the enrollment seasons at the end of every year. But that isn’t the only time your clients can enroll in or make changes to a health insurance plan. A qualifying life event (QLE) is a life change that allows someone to enroll or make changes to their plan outside of the yearly enrollment period.
Since QLEs are one-off events that happen anytime throughout the year, they can easily get lost in the shuffle, especially if your processes to manage them are manual. However, they are still crucial moments for your clients. They can be an excellent opportunity to provide value and show you care, building crucial client relationships that will ultimately increase client retention.
Keep reading to learn more about what QLEs are and the types of QLEs that occur. Then, discover what to do when a client is eligible to make health insurance plan updates, and how you can use technology, like AgencyBloc’s AMS+ and Quote+ solutions, to streamline your agency’s QLE processes.
What is a Qualifying Life Event?
According to HealthCare.gov, a qualifying life event is a significant change in a person’s life circumstances that allows them to enroll in or modify their health insurance coverage outside the standard Open Enrollment Period, making them eligible for a Special Enrollment Period (SEP). These events can significantly impact your clients’ insurance needs, prompting the need for coverage adjustments.
The length of the Special Enrollment Period depends on the type of qualifying life event. For most QLEs, the window to enroll is either 60 days before or 60 days after the event. Job-based plans must provide a window of at least 30 days.
Types of Qualifying Life Events
Qualifying life events fall into one of four categories:
- Loss of health coverage
- Changes in household
- Changes in residence
- Other qualifying events
Medicare qualifying life events also typically fall into one of these four categories and are generally the same as employee benefits/group and individual insurance QLEs.
1. Loss of Health Coverage
A common QLE health insurance scenario is the loss of current coverage. This might occur due to:
- Losing job-based health insurance
- Turning 26 and no longer being eligible for coverage under a parent’s plan
- Losing eligibility for Medicare, Medicaid, or Children’s Health Insurance Program (CHIP)
2. Changes in Household
Qualifying life events often involve changes to a person’s family structure. These can include:
- Getting married or divorced
- Having a baby or adopting a child
- Death of a family member covered by their current plan, including the death of the primary policyholder
3. Changes in Residence
Moving to a new area can also trigger a qualified life event for insurance purposes. This includes:
- Relocating to a different ZIP code, county, or state
- Moving to or from the place one attends school as a student
- Transitioning to or from a shelter or other temporary housing
4. Other Qualifying Events
There are also other qualifying events that fall outside the previous three categories that are eligible for a Special Enrollment Period. This includes:
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Next Steps After a Qualifying Life Event
Once a qualifying life event occurs, what happens next? First, your client should notify you or their employer about a change, or indicate in their enrollment platform that a QLE has occurred. Then, you can confirm their eligibility for a Special Enrollment Period for that QLE.
Next, depending on the QLE, documentation may need to be obtained from your client in order to proceed. Examples of proof of a qualifying life event could include:
- Marriage certificate
- Divorce or legal separation papers
- Birth certificate
- Notice of legal adoption
- Death certificate
- Lease or rental agreement
Once you have confirmed that the client is eligible for a Special Enrollment Period, you can continue the enrollment process and send the changes to the carrier. Remember that it’s essential to make sure your clients are enrolled within the Special Enrollment Period; if they miss the deadline, they will have to wait until the next enrollment period. Depending on the time of year, this could be as long as a year away.
Using Technology to Support Qualifying Life Events
Because qualifying life events are time-sensitive, it's crucial to enroll clients in a Special Enrollment Period promptly. Important tasks, communications, and more can slip through the cracks if your agency doesn't utilize tech, resulting in missed opportunities for you and your client.
Insurance agencies should stay organized year-round. The industry is filled with compliance regulations, and knowing you have your bases covered is key.
Although there are no blanket documentation requirements for qualifying life events, it doesn’t hurt to have this information on hand in the event that you need it. The U.S. Department of Health and Human Services implemented a program in 2016 to start verifying Special Enrollment Periods under the Affordable Care Act (ACA), and some carriers may request proof of a QLE. Luckily, many insurance-specific tech solutions allow you to attach documents to client profiles for safekeeping. Then, if you ever need to refer back to it, you know exactly where to find it — no more digging through emails or paper files!
Also, using an enrollment platform that can streamline the process is a game changer. It makes the enrollment process easier for your clients and makes your process as the agent significantly more efficient.
By using enrollment technology, you can:
- Act on QLEs faster
- Make sure you have the most up-to-date and accurate information in your systems
- Streamline and automate the carrier form submission process
- Gather employee medical health data quickly
Streamlining QLEs With AgencyBloc Solutions
AgencyBloc’s Plus Suite has the insurance technology solutions to make accommodating qualifying life events more effortless than ever before.
With Quote+, an AgencyBloc solution, you can be notified of qualifying life events right away. When an employee changes their information in Quote+ that affects their coverage, you have the option to be notified of this change via email. This will open up a Special Enrollment Period for the employee where they can select the changes they would like made to their plan(s).
Quote+ also streamlines group benefits enrollment for both the broker and the employee — during regular OEP and QLEs! Quote+ walks employees through the enrollment process step-by-step. Once the employee has selected their changes in coverage and completed enrollment, you as the broker can select and send the employee change forms to the carrier. The forms will be filled out automatically with the secure, HIPAA-compliant carrier mapping tools.
With AgencyBloc’s AMS+ solution, you can stay organized and keep track of vital client information. When a QLE occurs, create an Activity in AMS+ to remind yourself of the event. If a client gets married or has a baby, you can create records for the whole family and connect them together via relationships. Plus, AMS+ integrates with Quote+ and a variety of other third-party enrollment platforms.
Qualifying life events are inevitable in the health insurance industry. Making sure your agency is equipped to handle them in a timely manner is crucial. By leveraging technology, like AgencyBloc’s Quote+ and AMS+ solutions, you can significantly streamline the QLE process.
See How Quote+ Can Transform Your Enrollment Processes
Now, brokers can make enrollment easier than ever before with self-guided employee plan election and enrollment tools and automated carrier form submissions.
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Posted
by Sarah Rosonke
on Tuesday, November 19, 2024
in
Quote+
- data management
- productivity
- quoting
About The Author
Sarah is the Design and Content Specialist at AgencyBloc. She creates and designs helpful resources to support life and health insurance agencies in growing and automating their business. Favorite quote: "You'll never do a whole lot unless you're brave enough to try." —Dol
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