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.