Changing Coverage (Qualified Status Changes)
Because contributions for most benefits are deducted on a pre-tax basis, IRS regulations require that a participant, once enrolled, may not change his or her election until the next Open Enrollment period unless he or she experiences a qualified status change.
Experiencing a qualified status change allows a participant to change the level of coverage (but not to switch plans) within 31 days of the event. Qualified status changes include, but are not limited to:
- Adding a dependent through marriage, registered domestic partnership, birth, adoption or legal guardianship;
- Losing a dependent through legal separation, annulment, divorce, dissolving of a registered domestic partnership or death;
- Dependent's gain or loss of eligibility by becoming a full-time student, attaining age of ineligibility or ceasing to be a full-time student;
- Loss of other health insurance coverage through the employer of a spouse or registered domestic partner (for example, because of layoff, termination, disability, severance, substantial reduction in benefits or reduction in work hours);
- Gaining eligibility for other coverage through a spouse's plan, COBRA or Medicare (or MediCal in California);
- Receiving a court order — a Qualified Medical Child Support Order (QMCSO) — requiring the addition of medical coverage for children not in the participant's custody;
- Changing residence and thereby affecting access to a plan service area; and
- Changing child or adult care situations, such as providers or costs.
To make a change due to a qualified change in status, participants must complete a Benefits Enrollment and Change Form (196k). Participants may also be asked to submit proof of the qualified status change and other relevant documentation.
Participants must contact their group Human Resources/Benefits POC within 31 days of a qualified status change event.
