Changes in benefits after the open enrollment period can only be made if you have a qualifying event. (ex. marriage, divorce, birth or adoption of a child, spouse loss of coverage)
What is a Qualifying Event?
A qualifying event is a life-changing event that causes a change in the level of coverage or eligibility for coverage of health insurance benefits. It is a personal change in the employee's status which allows them under the IRS "Change of Status" regulations to make a change to health insurance benefits with the district.
Ex. Birth, Adoption, Death, Marriage, Divorce, Involuntary loss of coverage in another group plan., Gaining other coverage in another group plan
What are the requirements to make a change?
- You only have 31 calendar days from the date of the qualifying event to make a change.
- You are required to fill out and turn in the "Benefit Change Form" within 31 calendar days of the qualifying event.
- You are required to send supporting documentation within 31 calendar days of the qualifying event.
- Birth - Verification of Birth Facts, Birth Certificate
- Adoption - Adoption papers
- Death - Death Certificate
- Marriage - Marriage license
- Divorce - (if results in loss of coverage) Divorce decree (First and last pages with judge's signature)
- Involuntary loss of coverage - Certificate of Creditable Coverage or statement on letterhead from the terminating group insurance plan. The following must be included:
- who was covered
- why coverage is ending
- the date coverage ends
- must clearly indicate the coverage for health and/or dental
- insurance company name
- policy number
- Gaining other coverage in another group plan - You must submit a statement on letterhead from the new insurance provider or a copy of the new insurance card. The following must be included:
- who is covered
- when coverage started
- policy number
- type of coverage