Changes Due to Change in Family Status
In addition to changes permitted during open enrollment, a participant may change health, dental, vision, optional long-term disability, spending accounts (health and dependent care) coverage during a plan year because of a change in family status. Generally, a participant may change his or her coverage if the change is on account of and corresponds with a change in family status that affects eligibility for coverage. Changes to optional long-term disability coverage, however, may be made even if the change in family status does not affect eligibility for long-term disability coverage. The participant must notify the Benefits Office within 31 days of the change in family status.
The following table summarizes the events that are known as “changes in family status” and shows the different types of coverage that may be changed for each change in family status. This table is only a summary, however. Whether a change to coverage can be made in any individual instance depends on the particular facts and circumstances of the employee’s situation but the change must affect eligibility for the coverage under the plan for which the change is made.
|This family status change …||will generally allow a change in …|
|marriage||health, dental, healthcare flexible spending, dependent care flexible spending, optional Life, LTD, vision|
|death of a spouse||health, dental, healthcare flexible spending, dependent care flexible spending, optional Life, LTD, vision|
|divorce, legal separation, or annulment||health, dental,healthcare flexible spending, dependent care flexible spending, optional Life, LTD, vision|
|change in number of dependents (birth, adoption, placement for adoption, or death)||health, dental, healthcare flexible spending, dependent care flexible spending, optional Life, LTD, vision|
|change in employment status, such as
|dependent satisfies or ceases to satisfy the requirements to be a dependent under the coverage||health, dental, dependent care flexible spending, optional Life, LTD, vision|
|change of residence||health, dental, dependent care flexible spending, optional Life, LTD, vision|
Other Permitted Changes
Employees may also be able to make changes to their coverage elections in the following circumstances:
- The employee, employee’s spouse, or employee’s dependent elects COBRA continuation of health coverage.
- A judgment, decree or order resulting from a divorce, legal separation, annulment or change in custody requires the employee to include or permits the employee to remove a child from coverage.
- The employee, employee’s spouse, or employee’s dependent becomes enrolled or loses eligibility for coverage under Part A or B of Medicare.
- The employee takes unpaid leave under the Family and Medical Leave Act (FMLA).
- Changes in Cost. If the cost of coverage significantly increases or decreases during the year, an employee may make certain changes to the coverage he or she has elected. For example, if the cost of coverage that an employee has chosen significantly increases during the year, an employee may choose to (1) make an increase in his or her pre-tax contributions for that coverage, (2) drop that coverage and choose coverage under another Plan option, if any, that provides similar coverage, or (3) drop coverage altogether if no similar coverage exists. If the cost of an option that the employee has not chosen significantly decreases during the year, an employee may elect to enroll in that option during the year, including dropping his or her similar coverage that has not decreased in cost.
- Changes in Coverage. If coverage is significantly curtailed, an employee may drop that coverage and elect coverage under another option that provides similar coverage or to drop coverage if no similar coverage option is available. If the significant curtailment amounts to a complete loss of coverage, the employee may also drop coverage altogether if no other similar coverage is available. Further, if the Plan adds or significantly improves a benefit option during the year, an employee may drop his or her current coverage and elect to receive, on a prospective basis, coverage provided by the newly added or significantly improved option, so long as the newly added or significantly improved option provides similar coverage to the coverage that is dropped.
HMO Changes Due to a Temporary Change of Residence
Employees enrolled in an HMO and planning to reside temporarily beyond the local area are advised to consult with the Benefits Office prior to departing. They may need or want to change their health plan. If a change is required, the employee may be allowed to make the change at the time of the move rather than waiting until the next open enrollment period.
The allowable coverage changes described in this section are not intended to serve as a list of all permissible mid-year coverage changes. Please contact the Plan Administrator for more information.