What is a Qualifying Event?
A qualifying event is an occurrence (such as death, termination of employment, divorce, etc.) that changes an employee’s eligibility status under a group health plan. The term is frequently used in reference to COBRA eligibility, but it can also refer to an event enabling an active employee to make a coverage change at some time other than open enrollment.
The qualifying event requirement is satisfied if the event is (1) the death of a covered employee; (2) the termination (other than by reason of the employee’s gross misconduct), or a reduction of hours, of a covered employee’s employment; (3) the divorce or legal separation of a covered employee from the employee’s spouse; (4) a covered employee becoming entitled to Medicare benefits under Title XVIII of the Social Security Act; or (5) a dependent child ceasing to be a dependent child of the covered employee under the generally applicable requirements of the plan and a loss of coverage occurs.
The qualifying event requirement is satisfied if the event is (1) the death of a covered employee; (2) the termination (other than by reason of the employee’s gross misconduct Although illegal or dangerous acts committed in the workplace are likely to qualify as gross misconduct, the acts need not be criminal or otherwise unlawful in nature. In some instances, even acts that occur away from the workplace have qualified as gross misconduct. A definition widely used by the courts goes something like this: Acts of gross misconduct are intentional, wanton, willful, deliberate, reckless, or in deliberate indifference to an employer\’s interest. Often, acts that will prompt an employer to terminate an employee are those done in deliberate violation of the employer\’s known standards. However, those acts may not constitute gross misconduct for COBRA purposes unless they go beyond simple negligence or incompetence.’); return false”>gross misconduct), or a reduction of hours, of a covered emplo
The qualifying event requirement is satisfied if the event that would otherwise result in the loss of coverage is (1) the death of a covered employee; (2) the termination (other than by reason of the employee’s gross misconduct), or a reduction of hours, of a covered employee’s employment; (3) the divorce or legal separation of a covered employee from the employee’s spouse; (4) a covered employee becoming entitled to Medicare benefits under Title XVIII of the Social Security Act; or (5) a dependent child ceasing to be a dependent child of the covered employee under the generally applicable requirements of the plan and a loss of coverage occurs.
Related Questions
- If Anthem performs COBRA administration for the plan, how does the employer notify Anthem that a Qualifying Event has occurred and how much time does the employer have to notify Anthem?
- How long after a qualifying event does an employee have to elect COBRA coverage?
- Is college graduation a qualifying event for health insurance?
