What To Do After a Qualifying Life Event

FALLS CHURCH, Va. – When you get married or move to a new state, updating your health plan probably isn’t the first thing on your mind. But when it comes to your health care coverage, personal milestones like these, as well as many other changes in your life, are known as Qualifying Life Events (QLEs). A QLE opens a 90-day period for you—and your family—to make eligible changes to your TRICARE health plan outside of open season.

In most cases, having a QLE requires you to take some form of action within 90 days. That’s why it’s important to know what types of events are QLEs and what to do if you experience one.

What Counts as a QLE
As outlined in the TRICARE Qualifying Life Events Fact Sheet, TRICARE QLEs include military, family, and government-directed changes. Some common examples are:

Gaining or losing other health insurance. This includes employer-sponsored health insurance, Medicare entitlement, or Medicaid entitlement.
Change in family composition. This includes getting married, getting divorced, and having a baby.
Change of address. This includes moving to a new city or country and moving away to college.
Change in sponsor status that results in ineligibility to continue existing coverage. This includes retiring from active duty and separating from active duty.
Losing sponsor or family member eligibility that results in ineligibility to continue existing coverage. This includes when a Retired Reserve member turns age 60 and when a sponsor or family member turns age 65 and becomes eligible for Medicare.
Government-directed changes. This includes a government-directed primary care manager change.

Rules and restrictions apply to each QLE. Visit Qualifying Life Events for a full list of QLEs and more information about each one.

Actions Following a QLE
When you or a family member experiences a QLE, you should update your information in the Defense Enrollment Eligibility Reporting System—also known as DEERS—as soon as possible.

“Because you only have within 90 days of a QLE to enroll in a TRICARE plan or change plans, it’s important to keep your DEERS record current,” said Shane Pham, program analyst with TRICARE Health Plan’s Policy and Programs Section at the Defense Health Agency. “An outdated DEERS record could cause you to miss enrollment deadlines. In some cases, you won’t have another opportunity to make enrollment changes until TRICARE Open Season.”

After you’ve updated DEERS, you can make eligible changes to your health plan. Depending on the type of QLE and your situation, you may have the following options for continuing or starting health care coverage:

Stay in the same plan, if you remain eligible for your current health plan and want to continue coverage.
Change plans, if you need to or want to, within 90 days of the date of the QLE.
Enroll in a plan, if you’re eligible for TRICARE but not already enrolled in a TRICARE health plan, within 90 days of the date of the QLE.

Some QLEs may mean you or your family members become newly eligible for certain premium-based health plans (TRICARE Reserve Select, TRICARE Retired Reserve, and TRICARE Young Adult). With premium-based health plans, you can enroll anytime throughout the year. Remember, a QLE may also mean you’re no longer eligible for a TRICARE health plan. You can visit the TRICARE Plan Finder to learn about which plans you may be eligible for based on your QLE.

To learn more about QLEs, check out Qualifying Life Events and the TRICARE Qualifying Life Events Fact Sheet. If you need help enrolling in a health plan, review Enroll or Purchase a Plan or reach out to your TRICARE regional contractor.

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