Qualifying Life Events (QLE)

Once a plan and/or membership election is made, it is irrevocable until the next Open Enrollment unless a recognized Qualifying Life Event (QLE) occurs. Outside Open Enrollment, changes may be made only with a QLE that is on account of and consistent with your Status Change. The following is a summary of recognized QLEs:

Change in Employee's Employment Status

• Begins/ends full-time employment
• Begins/ends leave without pay or family medical leave
• Begins retirement

Change in Your Marital Status

• Marriage, divorce or death of a spouse

Change in Your Number of Eligible Family Members

• Birth or adoption (DHRM must review all pre-adoptive placements to verify eligibility)
• Death of a covered child
• Covered child loses eligibility coverage under your plan
• Judgment, decree or order requiring coverage of a child
• Permanent custody of a child
• Social Services order requiring coverage of a child

Changes Affecting Your Family Member(s) Employment

• Spouse or covered child gains employer health plan eligibility (including switching from part-time to full-time employment)
• Spouse or eligible child loses employer eligibility (including switching from full-time to part-time employment)

Other Changes Affecting Your Dependent(s)

• Annual enrollment or significant change allowed under another employer's plan
• Gains/loses eligibility for Medicare or Medicaid

Changes Due to Special Circumstances

• Employee or dependent moves in or out of plan's service area
• HIPAA special enrollment due to loss of other coverage *
• You or a family member permanently change residence, affecting eligibility for the Plan
• A court has required that another party cover your children

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.

EFFECTIVE DATES:

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, or the event date, whichever is the later date AND 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).