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Changing Your Coverage
When you first become eligible for benefits, you will have the opportunity to review all your benefit options and then select those that
best meet your needs. These benefit elections will remain in place until the end of the current plan year (which ends December 31st of
each year) unless you experience a qualifying event. Similarly, during each annual enrollment you will have the opportunity to review
and elect benefit options and these elections will remain in place until the end of the plan year (which ends December 31st of each
year) unless you experience a qualifying event. A Qualifying Event (Q/E) is also referred to as a “Change in (family) Status”.
If you have a Change in Status during the plan year, you may be able to make changes to your benefits within 30 days of the Q/E. In
most cases, only changes consistent with the Change in Status can be made. Your Human Resources department can explain in more
detail the types of coverage changes you can make when you have a Change in Status. Following are some examples of Changes in
Status:
• Employee’s change in marital status (marriage or divorce) or death of spouse
• Birth, adoption or death of a dependent child
• Change in employee’s, spouse’s or dependent child’s employment status that affects benefit eligibility (for example full time to
part time status; leave without pay)
• Child becoming ineligible for coverage due to reaching age limit
• Employee’s receipt of a qualified medical child support order or letter from the Attorney General ordering the employee to provide
(or allowing the employee to drop) medical coverage for a covered child
• Changes made by a spouse or dependent child during his/her annual enrollment period with another employer
• Becoming eligible or ineligible for Medicare or Medicaid
• Significant changes in or cancellation of coverage
Effective dates of coverage for changes
All approved benefit election changes resulting from a qualified change in status or special enrollment will be effective on the first day
of the month following the receipt and approval of your completed Change-in-Status form and proof of change in status or special-
enrollment event documentation. However, in the case of a birth, adoption, or placement for adoption the effective date for the
benefit election change will be the day of the event. Remember that your completed Change-in-Status form must be received within
30 days from the date of the change in status or special-enrollment event.
Waiving Coverage
If you choose not to enroll in any of the benefit plans when you are first eligible, you must indicate your decision to waive select benefits by
“opting out” of the plan(s) by completing a benefit waiver form. If you decline coverage because you are covered under another medical
plan option, you must state this reason in writing in order to qualify for future special enrollments under HIPAA.
Coverage for your new dependent becomes effective as follows:
DEPENDENT
EFFECTIVE DATE OF COVERAGE
Spouse (marriage)
Date of marriage
Newborn Child(ren)
Your child’s date of birth
Adopted Child(ren)
The date of adoption or placement for
adoption
How and When May I Change My Elections
You must notify
Human Resources
within 30 days of a
Qualifying Event