Changing coverage

 
 

Benefits Summary Plan Description

Changing coverage

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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 loss of eligibility by attaining age 26*;
  • 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 or registered domestic partner'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.
Benefit Change Must be Consistent with Qualified Status Change

Any changes made outside of the Open Enrollment period must be consistent with the qualified status change event. The participant may add a spouse as a dependent, for example, after a marriage, but may not change from one plan to another. A qualified status change does not occur when a participant's provider leaves a plan or network.

Participants must contact their Benefits POC within 31 days of a qualified status change event.

* TRICARE Supplement coverage is available to unmarried dependent children under age 21 (or under age 23 if a full-time student). It is available to unmarried dependent children younger than age 26 if the participant is enrolled in the TRICARE Young Adult (TYA) program and as long as the children are not eligible for other employer-sponsored health coverage. Domestic partners and domestic partner children are not eligible for coverage under the TRICARE Supplement plan.