Once a plan and/or membership election is made, it is irrevocable until the next Open Enrollment unless a recognized Qualifying Mid-Year Event (QME) occurs. Outside Open Enrollment, changes may be made only with a QME that is on account of and consistent with your Status Change. The following is a summary of recognized QMEs:
Change in Employee's Employment Status
Change in Your Marital Status
Change in Your Number of Eligible Family Members
Changes Affecting Your Family Member(s) Employment
Other Changes Affecting Your Dependent(s)
Changes Due to Special Circumstances
If you move in or out of your plan's service area
You may change plan or membership if you move in or out of your plan's service area and submit your request within the timeframe allowed by your group’s plan (no longer than 60 days of the event). The change will be effective the first of the month after the request and enrollment form is received.
* Under HIPAA, if you lose your group health coverage, you may be able to enter another group health plan for which you are eligible (such as a spouse's plan), even if the plan generally does not accept late enrollees. Special enrollment rights are also triggered by marriage, birth, adoption, and placement for adoption.
All changes must be made on a prospective basis except in the case of birth, adoption or placement for adoption. Changes will be effective the first of the month following submission of the Enrollment Form, if the form is submitted within the timeframe allowed by your group’s plan (no longer than 60 days of the event). Changes for the birth, adoption, or placement for adoption will continue to be made on the first day of the month in which the birth, adoption or placement for adoption occurs, so long as notification occurs within the timeframe allowed by your group’s plan (no longer than 60 days of the event).