Updating benefits for qualifying life events (QLE)

A qualifying life eventqualifying life event A change in life—such as marriage, birth, or loss of other coverage—that may allow employees to change benefits mid-year. (QLE) is a major life change—such as moving to a new state, getting married, having a baby, or losing other health coverage—that allows you to update or change your health insurance outside the annual Open Enrollment Period (OEP).

The rules for QLE changes differ than those for OEP:

• Changes typically take effect on the first day of the month following carrier processing.
• Some carriers enforce a 15th of the month cutoff: requests received before the 15th go into effect the 1st of the following month; requests received after the 15th go into effect in 2 months.
• Insurance carriers require documentation proving the QLE occurred. You will be prompted to provide this when you notify Thatch of your plan change request.

caution

If you experience a QLE and need to change your coverage, you generally have 30 days from the date of your QLE to report it to Thatch and initiate the plan change process. For example, if you got married on January 15, you have from January 15 until February 14 to add your new spouse to your insurance plan.

Change your coverage

In the Thatch dashboard, click Change dependents or plans to update your enrollment information. In the resulting form, provide:

• The QLE event you've experienced (or will experience)
• The date of your QLE
• Supporting documentation (see the Documentation requirements section below)

info

If your QLE type isn't listed in the Thatch dashboard or you need help with a plan change, reach out to our support team through Ask Thatch.

Types of qualifying life eventsqualifying life event A change in life—such as marriage, birth, or loss of other coverage—that may allow employees to change benefits mid-year.

Change in household size

Definition: Events that add or remove someone from your taxable household—such as birth, adoption, marriage, divorce, or death of a spouse or dependent.

What you can change:

• Add new dependents to your plan
• Remove dependents who are no longer eligible
• Choose a new medical plan that better fits your updated household

When you can request changes: Carriers only process changes after the event has occurred.

When changes take effect:

• Coverage for a newborn or adopted child can start as of the child's date of birth or adoption, if you act within 30 days
• For other household changes, new coverage typically starts on the 1st of the month after you enroll

Change in residence

Definition: Moving to a new ZIP code, county, or state that changes the health plans available to you.

What you can change: End your current plan and select a new plan available in your new service area.

When you can request changes: Some carriers allow submission before the move date if proof of move is provided (like a lease or job relocation letter). Reach out to support for specific guidelines for your carrier.

When changes take effect:

• New coverage starts the 1st of the month after you enroll, if completed by the cutoff
• Your old plan remains active until the end of the current month

Notes:

• When you enroll in a new plan through Thatch after moving, you do not need to cancel your previous plan. That transition is handled for you—your current plan ends when your new plan begins.
• Special enrollment periodsSpecial Enrollment Period A time outside the yearly Open Enrollment Period when employees can sign up for health insurance. A SEP is triggered by a qualifying event such as losing health coverage or getting married. for a move typically last up to 60 days from the date of relocation but report your move to Thatch as soon as possible.
• You may be able to keep your plan even after changing states. However, the plan may not provide optimal coverage in the new state, so you should evaluate all plan options.

Loss of other medical coverage

Definition: You or someone in your household lost previous health insurance—such as loss of employer-sponsored coverage, expiration of COBRACOBRA A federal law that allows employees to temporarily continue employer-sponsored health insurance after leaving a job, reducing work hours, or experiencing other qualifying events. Employees typically pay the full premium cost plus an administrative fee. from a previous employer, aging off a parent's plan at 26, loss of Medicaid/CHIP eligibility, or involuntary loss of a subsidy or coverage.

What you can change:

• If you lose coverage, you can enroll in a plan through Thatch
• If someone in your household loses coverage, they can be added to your existing plan

When you can request changes: You can apply up to 30 days before the coverage end date, so new coverage starts the day after the old one ends.

When changes take effect: Coverage usually starts the 1st of the following month if you enroll by the cutoff.

Change in Thatch eligibility

Definition: You newly become eligible for your employer's Thatch allowanceallowance The amount an employer makes available to help employees pay for coverage or eligible expenses.—for example, your employer is newly offering an ICHRA benefit, you're a new hire at a company that already offers ICHRA, or you move from part-time to full-time status and gain ICHRA eligibility.

What you can change: Accept your Thatch allowanceallowance The amount an employer makes available to help employees pay for coverage or eligible expenses. and enroll in a medical plan through Thatch.

When changes take effect: Coverage usually starts the 1st of the following month if you enroll by the cutoff.

Change in immigration status or release from incarceration

Definition: You or someone in your household experiences a change in a certain legal status—such as gaining lawful permanent resident (green card) status, becoming a U.S. citizen, gaining refugee or asylum status, receiving Temporary Protected Status (TPS) or Deferred Enforced Departure (DED), or release from jail or prison.

What you can change:

• If you didn't have coverage before: enroll in a new health plan through Thatch
• If you already had coverage: switch to a new plan if your status change affects eligibility or access to plans in your area
• If the status change applies to a dependent: add them to your coverage

When you can request changes: Carriers only process changes after the event has occurred.

When changes take effect: Coverage usually starts the 1st of the following month if you enroll by the cutoff.

Documentation requirements

You'll need to provide to Thatch documentation as proof the QLE. The specific documentation required varies by QLE type.

QLE Type	Documents required
Birth	Birth certificate or hospital discharge paperwork
Adoption	Adoption papers or official placement documents
Marriage	Marriage certificate (Your spouse may also need to provide proof of prior or existing medical coverage)
Divorce	Divorce decree or legal separation paperwork (May require a cancellation letter from the previous insurance companyinsurance company The company that provides insurance coverage. Also called an insurance provider. showing the last date of coverage)
Death	Death certificate or obituary notice
Change in residence	At least 2 documents: proof of new residence (signed lease, deed or purchase agreement, driver's license or state ID with new address, utility bill with new address, prison release form, or paperwork confirming departure from active military service) plus proof of prior medical coverage
Loss of medical coverage	Termination or separation notice from your employer (if you previously had employer-based coverage), or documentation from your previous plan (for other health plans, COBRACOBRA A federal law that allows employees to temporarily continue employer-sponsored health insurance after leaving a job, reducing work hours, or experiencing other qualifying events. Employees typically pay the full premium cost plus an administrative fee., Medicaid, etc.) showing termination date, people covered, and reason for coverage loss
Change in Thatch eligibility	ICHRA notice (included in your Thatch invitation email and in the Documents section of your dashboard under Plan Legal Documents)
Change in immigration status	Green card, Certificate of Naturalization, I-94 form, valid visa, passport with entry stamp, or other government document showing legal status
Membership in a federally recognized tribe	Tribal membership documentation
Release from incarceration	Official release papers, discharge document, or letter from a parole or probation officer

Non-qualifying events

Some situations feel like they should count as a QLE, but usually don't under federal and insurance companyinsurance company The company that provides insurance coverage. Also called an insurance provider. rules:

• Canceling a plan because it's too expensive or you found a better option
• Losing coverage due to unpaid premiumspremium The monthly amount paid to maintain health insurance coverage, regardless of whether any services are used that month.
• Getting a raise, bonus, or change in work hours
• Moving to a new ZIP code with the same plan options
• Premiumpremium The monthly amount paid to maintain health insurance coverage, regardless of whether any services are used that month. increases or plan benefit changes at the time of renewal
• Doctors leaving your network or medications changing
• Getting sick, pregnant, or having a condition worsen
• Filing for immigration status (before approval)