• 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.