[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"detail-sidebar-cat-1-en-105":3,"doc-seo-278730-105":53,"doc-detail-278730-en":126},{"code":4,"msg":5,"data":6},0,"success",[7,14,19,24,29,34,39,44,49],{"id":8,"doc_module":9,"doc_module_name":10,"category_name":11,"show_sort_weight":12,"slug":13},11,1,"Template","Presentations",90,"presentations",{"id":15,"doc_module":9,"doc_module_name":10,"category_name":16,"show_sort_weight":17,"slug":18},12,"Resumes",80,"resumes",{"id":20,"doc_module":9,"doc_module_name":10,"category_name":21,"show_sort_weight":22,"slug":23},14,"Invoices",70,"invoices",{"id":25,"doc_module":9,"doc_module_name":10,"category_name":26,"show_sort_weight":27,"slug":28},15,"Posters",60,"posters",{"id":30,"doc_module":9,"doc_module_name":10,"category_name":31,"show_sort_weight":32,"slug":33},16,"Social Media",50,"social-media",{"id":35,"doc_module":9,"doc_module_name":10,"category_name":36,"show_sort_weight":37,"slug":38},17,"Forms",40,"forms",{"id":40,"doc_module":9,"doc_module_name":10,"category_name":41,"show_sort_weight":42,"slug":43},18,"Letters",30,"letters",{"id":45,"doc_module":9,"doc_module_name":10,"category_name":46,"show_sort_weight":47,"slug":48},21,"Paper Templates",5,"papers-templates",{"id":50,"doc_module":9,"doc_module_name":10,"category_name":51,"show_sort_weight":4,"slug":52},158,"General","general-158",{"code":4,"msg":54,"data":55},"ok",{"site_id":56,"language":57,"slug":58,"title":59,"keywords":60,"description":61,"schema_data":62,"social_meta":119,"head_meta":121,"extra_data":123,"updated_unix":125},105,"en","qualifying-life-event-documentation-checklist-plan-change-proof-requirements","Qualifying Life Event Documentation Checklist - Plan Change Proof Requirements","","Qualifying Life Event documentation checklist detailing required plan-change timelines and supporting evidence for enrollment, disenrollment, and retroactive coverage. Outlines what employees must upload for multiple QLE scenarios including birth, adoption, court-ordered custody, gain or loss of coverage, death of a spouse or dependent, divorce, marriage, and Medicaid gain or loss. Specifies permissible changes and lists required documents such as proof letters, certified certificates, enrollment confirmations, effective dates, provider names, and court or sealed decrees for approval.",{"@graph":63,"@context":118},[64,80,101],{"@type":65,"itemListElement":66},"BreadcrumbList",[67,71,74,77],{"item":68,"name":69,"@type":70,"position":9},"https://docshare.wps.com","Home","ListItem",{"item":72,"name":10,"@type":70,"position":73},"https://docshare.wps.com/template/",2,{"item":75,"name":36,"@type":70,"position":76},"https://docshare.wps.com/template/forms/",3,{"item":78,"name":59,"@type":70,"position":79},"https://docshare.wps.com/template/qualifying-life-event-documentation-checklist-plan-change-proof-requirements/278730/",4,{"url":78,"name":59,"@type":81,"image":82,"author":87,"headline":59,"publisher":90,"fileFormat":93,"inLanguage":57,"description":61,"dateModified":94,"datePublished":95,"encodingFormat":93,"isAccessibleForFree":96,"interactionStatistic":97},"DigitalDocument",{"url":83,"@type":84,"width":85,"height":86},"https://docshare.wps.com/thumbnails/qualifying-life-event-documentation-checklist-plan-change-proof-requirements/278730.png","ImageObject",442,249,{"name":88,"@type":89},"McGucket","Person",{"url":68,"name":91,"@type":92},"DocShare","Organization","application/pdf","2026-11-02","2026-09-15",true,{"@type":98,"interactionType":99,"userInteractionCount":8},"InteractionCounter",{"@type":100},"ViewAction",{"@type":102,"mainEntity":103},"FAQPage",[104,110,114],{"name":105,"@type":106,"acceptedAnswer":107},"What is the employee’s responsibility for QLE plan changes?","Question",{"text":108,"@type":109},"The employee must provide proof of the qualifying life event and upload the documents for the Employee Benefits Office/Department to review and approve.","Answer",{"name":111,"@type":106,"acceptedAnswer":112},"What timelines apply to plan changes for Birth, Adoption, or Court Ordered Legal Custody?",{"text":113,"@type":109},"Temporary enrollment requires proof within 31 calendar days of the baby’s birthdate, and completing enrollment requires a certified birth certificate and Social Security number within 45 calendar days.",{"name":115,"@type":106,"acceptedAnswer":116},"What documents are typically required for a Medicaid gain or loss of coverage?",{"text":117,"@type":109},"For enrollment or disenrollment involving Medicaid, documentation includes a Medicaid coverage letter, the full name of the individual involved, and the effective date of Medicaid coverage terminated or gained.","https://schema.org",{"og:url":78,"og:type":120,"og:title":59,"og:site_name":91,"og:description":61},"article",{"robots":122,"canonical":78},"index,follow",{"doc_id":124,"site_id":56},278730,1790570084,{"code":4,"msg":5,"data":127},{"doc_id":124,"user_id":128,"nickname":88,"user_avatar":129,"doc_module":9,"category_id":35,"category_name":36,"doc_title":59,"doc_description":61,"doc_content":130,"file_id":131,"file_url":132,"file_type":133,"file_size":134,"view_count":8,"is_deleted":4,"is_public":9,"is_downloadable":9,"audit_status":9,"page_count":76,"language":135,"language_code":57,"site_id":56,"html_lang":57,"table_of_contents":136,"faqs":137,"seo_title":138,"seo_description":61,"update_tm":139,"read_time":9},1236954412713,"https://us-avatar.wpscdn.com/davatar_29158cc5080c5b710cf443261637dec0","Requested plan changes must be consistent with the event and any changes made to coverage must be made within 31 calendar days of the Qualifying Life Event (QLE) . It is the employee’s responsibility to provide proof of the QLE and upload the documents for the Employee Benefits Office to review and approve.  \nBirth, Adoption, or Court Ordered Legal Custody of a Child:  \nPermitted Changes:  \n• Enrollment of employee, spouse, and/or newly born/adopted/placed child  \n• Cancel your coverage if you enroll in your spouse's group plan  \n• Coverage must be retroactive to the date of birth/adoption  \nRequired Documents:  \n• A copy of the proof of birth letter from the hospital within 31 calendar days of the baby’s birthdate for a temporary enrollment.  \n• A copy of the state certified birth certificate and Social Security number within 45 calendar days of the baby’s birthdate to complete the enrollment.  \nIf adoption or court ordered custody, the final adoption decree or court order/guardianship papers will be required.  \nGain of Insurance Coverage:  \nPermitted Changes:  \n• Disenrollment of employee and/or individual(s) gaining insurance coverage.  \nRequired Documents:  \n• Enrollment confirmation or coverage letter,  \n• Full Name of the individual gaining insurance coverage,  \n• Effective date of new insurance coverage, and  \n• The name of the new insurance provider  \nLoss of Coverage:  \nPermitted Changes:  \n• Enrollment of employee and/or individual(s) losing coverage.  \nRequired Documents:  \nIf Enrollment of Employee and/or Eligible Dependent(s):  \n• Disenrollment confirmation or loss of coverage letter,  \n• Full Name of the individual losing insurance coverage, and  \n• Effective date of insurance terminated  \nDeath of Spouse/Dependent:  \nPermitted Changes:  \n• Disenrollment of deceased dependent  \nRequired Documents:  \n• Copy of Death Certificate  \nDivorce:  \nPermitted Changes:  \n• Enrollment of employee and/or any eligible dependent(s) losing coverage  \n• Disenrollment of former spouse  \n• Disenrollment of any dependent(s) enrolling in benefits with the former spouse's insurance plan.  \nRequired Documents:  \nIf Disenrollment of Spouse:  \n• Final divorce decree,  \n• Full name of both parties,  \n• Date the divorce was finalized (effective date), and  \n• Court seal  \nIf Disenrollment of Dependent(s):  \n• Enrollment confirmation or letter of new insurance coverage,  \n• Full Name of the individual gaining coverage,  \n• Effective date of new insurance coverage, and  \n• The name of the new insurance provider  \nIf Enrollment of Employee and/or Eligible Dependent(s):  \n• Disenrollment confirmation or loss of coverage letter,  \n• Full Name of the individual losing insurance coverage, and  \n• Effective date of insurance terminated  \nMarriage:  \nPermitted Changes:  \no Enrollment of employee, new spouse, and/or newly eligible dependents.  \no Disenrollment for dependents if enrolling in spouse's plan.  \no Disenrollment for employee if enrolling in spouse's plan.  \nRequired Documents:  \nIf Enrollment of Spouse and/or newly eligible dependents:  \n• Court certified marriage certificate, and  \n• Review Dependent Documentation and provide ALL proper documentation that applies.  \nIf Disenrollment of Dependent(s):  \n• Enrollment confirmation or coverage letter of new insurance coverage,  \n• Full Name of the individual gaining coverage,  \n• Effective date of new insurance coverage, and  \n• The name of the new insurance provider  \nIf Enrollment of Employee and/or Eligible Dependent(s):  \n• Disenrollment confirmation or loss of insurance coverage letter,  \n• Full Name of the individual losing insurance coverage, and  \n• Effective date of insurance coverage terminated  \nMedicaid-Gain or Loss of Coverage:  \nRequested plan changes must be consistent with the event and Any changes made to coverage must be made within 60 calendar days of the Qualifying Life Event (QLE) . If you filed an appeal requesting reconsideration of denial you have 90 calendar days from","cbCaib9PCHvlFsky","https://ap.wps.com/l/cbCaib9PCHvlFsky","pdf",245552,"English","# Birth, Adoption, or Court Ordered Legal Custody of a Child\n## Permitted Changes\n## Required Documents\n# Gain of Insurance Coverage\n## Permitted Changes\n## Required Documents\n# Loss of Coverage\n## Permitted Changes\n## Required Documents\n# Death of Spouse/Dependent\n## Permitted Changes\n## Required Documents\n# Divorce\n## Permitted Changes\n## Required Documents\n# Marriage\n## Permitted Changes\n## Required Documents\n# Medicaid-Gain or Loss of Coverage\n## Permitted Changes\n## Required Documents","[{\"question\":\"What is the employee’s responsibility for QLE plan changes?\",\"answer\":\"The employee must provide proof of the qualifying life event and upload the documents for the Employee Benefits Office/Department to review and approve.\"},{\"question\":\"What timelines apply to plan changes for Birth, Adoption, or Court Ordered Legal Custody?\",\"answer\":\"Temporary enrollment requires proof within 31 calendar days of the baby’s birthdate, and completing enrollment requires a certified birth certificate and Social Security number within 45 calendar days.\"},{\"question\":\"What documents are typically required for a Medicaid gain or loss of coverage?\",\"answer\":\"For enrollment or disenrollment involving Medicaid, documentation includes a Medicaid coverage letter, the full name of the individual involved, and the effective date of Medicaid coverage terminated or gained.\"}]","Qualifying Life Event Documentation Checklist - Plan Change Proof Requirements | PDF",1789512063]