Changing Coverage Due to Life Events

Changing Your Coverage

Each fall, you will have the opportunity to change your health options and/or your dependent coverage as outlined below.

Midyear Changes to Enrollment

Internal Revenue Service regulations allow you to start or stop participation or to change your contribution midyear if these changes are because of, and consistent with a qualified status change, as described below.

Except for changes resulting from a change in your residence, you may change only the coverage related to your new status. That is, if you have a new baby you can add the baby to your dependent coverage but you cannot switch to a new medical plan option. You must report this change to the ERC within 31 days following the qualifying event; 90 days to add newborns or adopted children, or no change can be made until the next open enrollment period to be effective the following January 1.

Special Enrollment Period

An eligible employee and/or dependent who did not enroll for coverage when first eligible or during an open enrollment period may enroll for coverage during a special enrollment period.

A special enrollment period is available if the following conditions are met:

  1. The eligible employee and/or dependent had existing health coverage under another plan when last eligible to enroll in the Plan, and
  2. Coverage under the prior plan was terminated as a result of loss of eligibility (including, without limitation, legal separation, divorce or death), termination of all employer contributions, or in the case of COBRA continuation coverage, the coverage was exhausted.

A special enrollment period is not available if coverage under the prior plan was terminated for cause or as a result of failure to pay premiums on a timely basis. Coverage under this Plan is effective only if the ERC receives a properly completed enrollment application within 31 days of the date coverage under the prior plan terminated.

Special enrollment also is available for an eligible employee and/or new dependents following the birth (or adoption or placement for adoption) of a child or marriage. Coverage under this Plan is effective only if the ERC receives a properly completed enrollment application within 90 days following the date of birth, adoption, placement for adoption, or within 31 days for marriage.

Special enrollment is also available for an eligible employee and/or eligible dependent if the eligible employee or eligible dependent lost coverage under a Medicaid Plan under Title XIX of the Social Security Act ("Medicaid") or under a State Child Health Insurance Plan under Title XXI of the Social Security Act ("CHIP"). Coverage under this Plan is effective only if the ERC receives a properly completed enrollment application within 60 days after the date on which the prior coverage was terminated.

Special enrollment may also be available if the eligible employee and/or dependent becomes eligible for premium assistance under the applicable state to purchase coverage under the Plan. This is a program where a state may opt to assist employed individuals with premium payment assistance for their employer's group health plan rather than direct enrollment in Medicaid or CHIP. Each state will notify the public if it implements a premium assistance program. Coverage under this Plan is effective only if the ERC receives a properly completed enrollment application within 60 days after the date on which the eligible employee and/or dependent became eligible for premium assistance under Medicaid or CHIP.

The effective date of the change is the qualifying event date. If the change is due to special enrollment following birth, adoption, or placement for adoption of a child, the effective date of the change is the date of birth, adoption, or placement for adoption.

Qualified Status Changes

The Company reserves the right to require supporting legal documentation to confirm the status change at any time. Qualified status changes include the following:

Legal Marital Status

Any event that changes an employee's legal marital status, including marriage, divorce, death of a spouse, legal separation or annulment.

Domestic Partner Status

Any event that causes the employee's domestic partner to satisfy or cease to satisfy the requirements for coverage.

Number of Dependents

Any event that changes the number of an employee's dependents, including birth, death, adoption or placement for adoption.

Employment Status

Any event that changes the employment status of an employee or his or her spouse/domestic partner or dependent, including termination, commencement of employment, moving from full-time to part-time status or vice versa, a strike or lockout, the commencement or return from an unpaid leave of absence, a change in worksite, or any other event that effects an individual's eligibility for coverage under the Plan.

Dependent Status

Any event that causes the employee's dependent to satisfy or cease to satisfy the requirements for coverage due to attainment of age or student status.

Residence

A change in the place of residence that affects an individual's eligibility for coverage under the Plan.

Note: If you cancel your spouse's coverage during the annual open enrollment period in anticipation of divorce and a divorce later occurs, your divorce may be a qualifying event. If your spouse notifies the ERC within 60 days of the final divorce date and can establish that you canceled their coverage in anticipation of divorce, COBRA coverage may be available to your spouse beginning the first of the month following the final divorce. (But not for the period between the date your spouse’s coverage was ended at open enrollment and the date of the divorce).

Remember, the benefit changes you make must be consistent with your qualified status change. For example, if you have a new baby you can add the baby to your current medical plan or increase your health care or dependent care FSA, but you cannot switch to a new medical plan option.

Required Documentation for Qualified Status Changes


Qualifying Event Documentation Required
Marriage Marriage certificate (no marriage licenses)
Domestic Partner Domestic partner certification form
Divorce Divorce decree signed by a judge and filed by the court
Legal separation Legal separation document signed by a judge and filed by the court
Death of a dependent Dependent's death certificate
Add a child (newborn) Birth certificate or birth announcement
Add a step-child Proof of residency with employee
Add an adopted child Placement for adoption court document
Add a foster child, grandchild, niece/nephew or any other child with whom the employee has a parent child relationship (child must live in the home with the employee) Legal guardianship document. Legal document filed with the court.
Add a child – QMCSO QMCSO
Employment status Certificate of loss of coverage. If certificate was not provided, then a letter from the prior plan sponsor or governmental agency is sufficient.
Loss of coverage Certificate of loss of coverage. If certificate was not provided, then a letter from the prior plan sponsor or governmental agency is sufficient.
Residence Address has been changed in SAP. If the address doesn’t affect the plan the employee is currently enrolled in, no change is allowed.
Spouse's/Domestic Partner's open enrollment Confirmation of benefits statement from spouse's/domestic partner's employer. Proof of open enrollment period (dates).
Dependent full-time student status Copy of the dependent's current class schedule.