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Qualifying Events

A Qualifying Event that allows you to add or drop coverage is a change in your family status or employment status that affects your need for medical, dental, and vision care coverages.

List of Qualifying Events

(a) Change in legal marital status  

  1. Marriage
  2. Death of spouse
  3. Divorce
  4. Legal separation
  5. Annulment

(b) Change in number of dependents

  1. Birth
  2. Adoption
  3. Placement for adoption
  4. Death of a dependent
  5. Entering into or terminating a same-sex domestic partnership

(c) Change in employment status

  1. Termination or commencement of employment of the employee, spouse, same-sex domestic partner or dependent (other than for termination of the employee for misconduct)

(d) Change in work schedule

  1. An increase or decrease in the number of hours of employment by the employee, spouse, same-sex domestic partner, or dependent
  2. A switch between full-time and part-time status
  3. A strike or lockout
  4. Commencement or return from an unpaid leave of absence

(e) Dependent satisfies or ceases to satisfy the requirements for dependent coverage

  1. Attainment of age

(f) Change in the place of residence or work site of the employee, spouse, same-sex domestic partner, or dependent

(g) Judgments, Decrees and Orders

If a judgment, decree or order, including a Qualified Medical Child Support Order (QMSCO), resulting from a divorce, separation, annulment or custody change requires your dependent child to be covered under the medical plan, you may change your election to provide coverage for the dependent child. If the order requires that another individual (such as your former spouse) cover the dependent child, you may change your election to revoke coverage for the dependent child.

Answers to Common Questions

When is the Open Enrollment period?

Open Enrollment usually occurs in October or November each year. Specific dates will be announced shortly before the Open Enrollment period begins.

What coverages can I change if I have a Qualifying Event?

For the Medical and/or Dental Plans, you may be eligible to add or delete dependents, or add or drop coverage. For the Reimbursement Accounts, you may be eligible to make changes to your contributions for the remainder of the calendar year.  The change(s) in coverage that you request must relate to the change that affects eligibility for coverage.

How do I change my coverage(s)?

You have 31 days from the date of a Qualifying Event to make changes to your medical, dental, and or vision care coverages for all items indicated above except (a)(3), (a)(4), and (e). You have 60 days from the date of a Qualifying Event to make changes to your medical, dental, and/or vision care coverages for items (a)(3), (a)(4), (e), and for changes related to CHIPRA. The change requested must relate to the change that affects eligibility for medical, dental and/or vision care coverages.

Changes are made by completing an enrollment form, available in the Benefits Office. The completed form must be submitted, with proof of the Qualifying Event, to the Benefits Office. Your premiums will then be changed for the remainder of the calendar year.

You must notify the Benefits Office within the applicable period. If you only notify the medical, dental and/or vision care companies directly, we may be unable to make the change until the next Open Enrollment period.

If you do not make a change to your medical dental, and/or vision care coverages within the applicable period indicated above, you must wait until the next Open Enrollment Period. If a dependent is no longer eligible for coverage and you do not remove that dependent from your coverage within the applicable period indicated above, his or her coverage will end as of the date he or she is no longer eligible. However, you must complete a Qualifying Event election form if you want to drop to a lower coverage tier (i.e. single or two-person coverage).

Are there any other circumstances under which I can enroll myself or a dependent?

Based on the provisions of the Children’s Health Insurance Program Reauthorization Act of 2009 (CHIPRA), employees and dependents that are eligible but not enrolled in the Medial Plan may enroll for coverage if the employee or dependent loses eligibility and is terminated from Medicaid or CHIP* coverage or the employee or dependent becomes eligible for a premium assistance subsidy under Medicaid or CHIP*.  

* CHIP (Children’s Health Insurance Program) is a state program designed to provide health care coverage for uninsured children and some adults.

When do coverage changes become effective?

Coverage will become effective as soon as administratively feasible after the Plan Administrator has approved the change in status, except that a new child may be added as of the date of birth, date of adoption or date of placement for adoption.

You must notify the Benefits Office within the applicable period. If you only notify the medical and/or dental insurance company directly, we may be unable to make the change until the next Open Enrollment period.

Significant Cost Increases, Curtailment of Coverage

If the Plan Administrator notifies you that the cost of your coverage under the medical, dental and/or vision care plans significantly increases during the Plan Year or there is a significant curtailment of coverage mid-year, you will have the opportunity to stop or change your coverage as permitted by the Plan Administrator.

Questions? Contact the Benefits Office.

For the fastest response, if you get a busy signal from the first number you try, please try one of the other two.

(631) 344-2877, 5126, or 3724