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Change in Family Status and
Qualifying Mid-Year Events
Once a plan and/or membership election is made, it is irrevocable until the next Open Enrollment unless a recognized Qualifying Mid-Year Event (QME) occurs. Outside Open Enrollment, membership, and plan changes may be made only with a QME that is on account of and consistent with your Status Change. Only specific events quality as a change in family status.
Change in your employment status:
- begins/ends full-time employment
- begins/ends leave without pay or family medical leave
- begins retirement
Change in your marital status:
- marriage, divorce, or death of a spouse
Change in your number of eligible family members:
- birth or adoption (DHRM must review all pre-adoptive placements to verify eligibility)
- death of a covered child
- covered child loses eligibility coverage under your plan (exceeds age limit, marries, becomes self-supporting, etc.)
- judgment, decree, or order requiring coverage of a child
- permanent custody of a child
Changes affecting your family member(s) employment:
- spouse or covered child gains employer health plan eligibility (including switching from part-time to full-time employment)
- spouse or eligible child loses employer eligibility (including switching from full-time to part-time employment)
- spouse begins/ends leave without pay
Other changes affecting your dependent(s):
- annual enrollment or significant change allowed under another employer's plan
- gain/losses eligibility for Medicare or Medicaid
- losses eligibility under another government-sponsored plan
Changes due to special circumstances:
- employee or dependent moves in or out of the plan's service area
- HIPAA special enrollment due to loss of other coverage*
- you or a family member permanently change residence, affecting eligibility for the Plan
- a court has required that another party cover your children
*Under HIPAA, if you lose your group health coverage, you may be able to enter another group health plan for which you are eligible (such as a spouse's plan), even if the plan generally does not accept late enrollees. Special enrollment rights are also triggered by marriage, birth, adoption, and placement for adoption.
How it Works:
If a qualifying event occurs, you must report it within 30 days. If you don't request a change in benefits within the 30-day period following your family change, you cannot make changes until the next open enrollment period.