• Employer provides four plans, with the following three that interest me, PPO, HMO, CDHP
  • During open-enrollment I choose PPO.
  • I marry. This counts as a QLE.

Am I allowed to change to CDHP midyear?

From my readings and understanding, this QLE only allows me to elect coverage for spouse under my current medical coverage.

Is my understanding correct that I may not change my health plan? Furthermore, no QLE exists that allows one to change health plan chosen during initial open-enrollment?

  • 1
    Is this in the United States?
    – yoozer8
    Nov 7, 2019 at 17:45
  • 1
    Assuming US based on the language used. Have you asked your plan administrator? The answer is going to vary based on factors we don't know (which state you live in, whether your coverage is employee- or government-based, and who the plan admin is). The customer service folks at your plan should be able to tell you, or you can find the answer in your plan documentation (or ask HR if it's employer based).
    – dwizum
    Nov 8, 2019 at 14:43
  • 2
    Can you provide a link to the document that you think limits your choices when there is a QLE? Nov 8, 2019 at 14:54

1 Answer 1


The below from appears to state one may be able to change one's plan.

Health Gov Site

Since the 2019 Open Enrollment Period is over, you can now enroll in or change a Health Insurance Marketplace plan only if you have a life event that qualifies you for a Special Enrollment Period.

Also this from law site regarding Marketplace

§ 155.420 Special enrollment periods.

(a) General requirements -

(1) General parameters. The Exchange must provide special enrollment periods consistent with this section, during which qualified individuals may enroll in QHPs and enrollees may change QHPs.

Though the above is only discussing plans purchases thru state marketplace. Adding as partial answer for other viewers.

  • Just as an FYI, even though this makes it sound like "yes, you can change your plan," Marketplace plan changes due to QLEs are usually fairly limited - but it depends on the specifics of the QLE and the plan you're already in. In some cases you can only change to certain other plans (i.e. in the same Metal), or you can enroll the new spouse in other plans but you're not allowed to change yours, and so on.
    – dwizum
    Nov 8, 2019 at 16:29
  • Dependent tiered coverage, like employee+spouse, isn't available to individuals, unlike employer plans. the question asks if a spouse must enroll as a dependent under the employee's chosen plan election, a situation that doesn't exist in individual markets.
    – quid
    Nov 9, 2019 at 16:20

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