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Overview

In general, the benefit plans and coverage levels you choose when you are first enrolled remain in effect for the remainder of the Plan Year in which you are enrolled. In addition, elections you make at Open Enrollment generally remain in effect for the entire Plan Year. If you experience one of the events described below and want to make a change to your coverage due to such event, you must notify your Employer within 30 days of the event, or 60 days for certain events as described under HIPAA Special Enrollment rules. If you do not notify your Employer within the allowed timeframe, you will not be able to make any changes to your coverage until the next Open Enrollment period.

Changes in Status

You may be able to change your Medical election during the Plan Year if you experience a change in status. Please note that in order to change your benefit elections due to a change in status, you may be required to show proof verifying that these events have occurred (e.g., copy of marriage or birth certificate, or divorce decree, etc.) The following is a list of changes in status that may allow you to make a change to your elections:

  • Legal marital status. Any event that changes your legal marital status, including marriage, divorce, death of a spouse, legal separation, and annulment;

  • Domestic Partner status. A change in your status due to establishing a domestic partnership, or dissolution of a domestic partnership.

  • Number of eligible dependents. Any event that changes your number of eligible dependents including birth, death, adoption, legal guardianship, and placement for adoption;

  • Employment status. Any event that changes your or your eligible dependents’ employment status that results in gaining or losing eligibility for coverage. Examples include: beginning or ending employment; a strike or lockout; starting or returning from an unpaid leave of absence; changing from part-time to full-time employment or vice versa; and a change in work location.

  • Dependent status. Any event that causes your dependents to become eligible or ineligible for coverage because of age, student status, or similar circumstances;

  • Residence. A change in the place of residence for you or your eligible dependents if the change results in your or your eligible dependents living outside your health plan’s network service area;

  • FMLA leave. Beginning or returning from an FMLA leave

Other Events that Allow You to Change Elections

There are several other events that are not official Status Change events per se, but that may allow you to make changes in your elections. 

  • QMCSOs. If a Qualified Medical Child Support Order (QMCSO) requires the Plan to provide coverage to your child, then the Plan Administrator automatically may change your election under the Plan to provide coverage for that child. In addition, you may make corresponding election changes as a result of the QMCSO, if you desire. If the QMCSO requires another person (such as your spouse or former spouse) to provide coverage for the child, then you may cancel coverage for that child under the Plan if you provide proof to the Plan Administrator that such other person actually provides the coverage for the child.

  • Coverage Change Events. In some instances, you can make elections if the type of coverage changes. Please note that if the change occurs to another employer’s plan, you may be required to show proof verifying these events have occurred. 

  • Restriction or Loss of Coverage. If your coverage is significantly restricted or ceases entirely, you may revoke your elections and elect coverage under another option that provides similar coverage. Coverage is considered “significantly restricted” if there is an overall reduction in benefits coverage. If the restriction is equivalent to a complete loss of coverage, and no other similar coverage is available, you may revoke your existing election.

  • Addition to or Improvement in Coverage. If your employer adds a coverage option or significantly improves a coverage option during the year, you may revoke your existing election and elect the newly added or newly improved option.

  • Changes in Coverage under another Employer Plan. If you or your eligible dependents are employed and the other employer plan allows for a change in your family member’s coverage (either during that employer’s Open Enrollment period or due to a mid-year election change permitted under the Internal Revenue Code), you may be able to make a corresponding election change under the Plan. For example, if your spouse elects family coverage during his or her employer’s Open Enrollment period, you may request to end your coverage under your employer’s plan.

  • Loss of Other Group Health Plan Coverage. If you or your spouse or dependent child(ren) lose coverage under another group health plan sponsored by a governmental or educational institution, including a state children’s health insurance program (CHIP), medical care program of an Indian Tribal government, state health benefits risk pool, or a foreign government group health plan, you may enroll for coverage under any other plan for which you are eligible.

Keywords: change in status, election