A Qualifying Life Event (QLE) is a change in your life that can make you eligible for a mid-year adjustment to your health coverage.
Having a Baby or Adoption of a child
Having a Baby or Adoption
This material will provide you with resources that can guide you toward your life goal--to bring your new child into your family and nurture the happiness and well-being of a precious child.
Contact your Human Resources Department for information about the benefit plans you may want to enroll your child in, and what paperwork is necessary.
After the birth or adoption (official placement or final decree), or court order, you may add the child to your existing medical, dental, or vision coverage, or drop your coverage to go on your spouse’s plan. You may elect to change your medical FSA amount, and start or change a dependent care FSA. You may also elect child life insurance. You will need to complete the appropriate forms and provide a copy of the certified birth certificate, adoption placement order or decree, or court order.
You must consult your HR Department within 30 days from the date of the event to make changes.
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Helpful Forms |
Change in Spouse's Coverage
Change in Spouse's Coverage
If your spouse has a change in benefits, you may be eligible to update your insurance plan.
The following 2 events will allow for a change in benefits.
1. If the spouse’s employer coverage causing gain or loss of coverage
2. Spouse changes coverage during Open Enrollment
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More Details You have 30 days from the date of the event to report the change to your employer. You may elect medical, dental, or vision coverage, or drop your coverage to go on your spouse’s plan. You may also elect to change your medical FSA amount. You will need to complete the appropriate forms and provide a letter from your spouse’s employer confirming the effective date of the change, listing all coverage being gained or lost, and listing all covered individuals. |
Marriage
Marriage
Deciding to get married is a major life step and one that is worthy of sincere congratulations.
Once you are married (check with your HR department for timeframes), you may add your spouse to your existing medical, dental, or vision coverage, enroll in a medical plan, change to another option or drop your coverage to go on your spouse’s plan. You may also elect to change your medical FSA amount, and elect spouse coverage under our various life and long term care plans. You will need to complete the appropriate forms and provide a copy of your certified marriage certificate. You should also review your beneficiary designations for life insurance, retirement savings, and pension plans.
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Other Benefit Plans Contact your Human Resources Department for information about adding a new dependent to your other benefit plans. Also, take the time to review your financial and insurance plans to make any changes to your coverage, contributions or beneficiary designations.
You must consult your HR Department within 30 days from the date of the event to make changes.
Social Security Card If you legally change your name because you get married, you will need to apply for a corrected Social Security card with your changed name. Failure to do so could delay a tax refund coming to you or prevent some of your pay from being credited properly to your Social Security record, which could cause your future Social Security benefits to be less than they should be. You will need to provide a recently issued document, such as your marriage license / certificate, as proof of your legal name change. If the document you provide does not give the Social Security Administration enough information to identify you in its records, you will be asked for an identity document showing your old name and another in your new name providing evidence of your identity. You will need to fill out an Application for a Social Security Card (SS-5) form and submit it to the Social Security Administration. You can download a copy of the SS-5 form and instructions in an electronic format from here and print it out at your leisure. The instructions include details on acceptable evidence of your identity. Also, you can visit the Social Security website or call 1-800-772-1213
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Separation and Divorce
Separation and Divorce
Ending a relationship usually involves questions about the division of property and often the custody of children. By having a quality support team, it will reduce the stress that couples and families feel during this experience.
Within 30 days of the date the divorce decree is signed, you may elect any medical coverage you are losing under your spouse’s plan. If you currently cover your spouse, you must drop his or her coverage for medical, dental, vision, and group term life, but continue to cover your children. You may also elect to change your medical and dependent care FSA amount. You will need to complete the appropriate forms and provide a copy of the first and last pages of your certified divorce decree. You should also review your beneficiary designations for life insurance, retirement savings, and pension plans. Prior to the final decree, you may not drop a spouse in anticipation of the final decree.
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Remove Spouse from Benefits If your spouse is no longer eligible for coverage, you should notify the Benefits Department to remove him or her from the benefit plans. Any stepchildren who are no longer eligible will also need to be removed from the plans. You may also obtain information on COBRA continuing coverage for your spouse. Conversely, if you and / or your children were covered by your spouse's plan, you will need to enroll yourself or your child / children in the appropriate plan(s). Contact your Human Resources Department for more information.
Review / Change Beneficiaries
Review and / or make any changes to your beneficiary information for all of your plans. Contact your Human Resource Department for information.
Emergency Contact Information You may want to make sure your Human Resources Department has the person you want on file should your employer need to contact someone in an emergency on your behalf. Contact your Human Resources Department for information on how to change your emergency contact information. |
The Loss of a Loved One
Loss of a Loved One
The death of a loved one, whether expected or unexpected, is often has a devastating effect on you and other family members.
Navigating the grieving process can be challenging, but the other changes associated with the loss of a loved one can also be difficult to comprehend and deal with. Getting your loved one's estate and finances in order, for example, can pose obstacles and certainly many questions. You'll need to review your loved one's papers as well as their benefits package.
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Notify Human Resources to remove dependents from benefit plans. Your employer Human Resources Department will work with the beneficiaries to handle the necessary paperwork. Within 30 days of the death, you may elect any medical coverage you are losing under your spouse’s plan. If you currently cover your deceased dependent, you must drop his or her coverage for medical, dental, or vision although you may continue to cover the rest of your family. You may also elect to change your medical and dependent care FSA amounts. Again, you should review your beneficiary designations for life insurance, retirement savings, and pension plans. You will need to complete the appropriate forms and provide a copy of the certified death certificate.
Note: In general, a certified copy of the death certificate will be required.
Social Security: Contact your nearest Social Security office for information on survivor benefits as the spouse or children may be entitled to a survivor benefit. For more information call (800) 772-1213.
Be prepared to provide:
Veterans Administration: For assistance in filing claims for veterans and survivor benefits, counseling or emergency financial assistance, contact:
Disabled American Veterans
P.O. Box 14301
Cincinnati, OH 45250-0301
(606) 441-6300
For information on military funerals, contact:
Veterans of Foreign Wars
VFW Memorial Building
200 Maryland Avenue, NE
Washington, DC 20002
(202) 543-2239
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Qualifying Life Event
Qualifying Life Event
A qualifying life event (QLE) is an event deemed acceptable by the IRS that may allow participants in cafeteria plans to change their benefit elections.
You may change your benefit elections during the annual Open Enrollment period or during the year if you experience a Qualifying Life Event. A Life Event change permits employees to make certain mid-year benefit changes consistent with the qualifying event. You must consult your Benefits Administrator within 31 days from the date of the event to make changes.
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Qualifying Life Events: 1. Special Enrollment Rights: An event described in the Special Enrollment provisions as shown in the group policy/plan;
2. Entitlement to or loss of eligibility for Medicare or Medicaid: The employee or the employee's dependent becomes entitled to or loses eligibility for Medicare (Part A or Part B) or Medicaid.
3. Special Requirements relating to the Family and Medical Leave Act (FMLA): An employee takes leave under FMLA, in which case the employee may revoke an existing election of health plan coverage and make such other election for the remaining portion of the period of coverage as may be provided for under FMLA.
4. Significant cost or coverage changes: Cost of coverage changes significantly.
5. A judgment, decree or order: Resulting from a divorce, legal separation, annulment, or change in legal custody (including a qualified child support order) that requires health coverage for an employee's dependent child or for a foster child who is a dependent of the employee.
6. Changes in status events, which include the following:
a) Legal marital status: Change in the employee's legal marital status, including marriage, death of spouse, divorce, legal separation and annulment;
b) Number of dependents: Change in the employee's number of dependents, including birth, death, adoption and placement for adoption.
c) Employment status: Change in the employment status of the employee or the employee's dependent, including termination or commencement of employment, a strike or lockout, a commencement of or return from an unpaid leave of absence or a change in worksite. This also includes a change in the employee's or the employee's dependent's employment status resulting in the individual becoming or ceasing to be eligible under the group policy/plan;
d) Eligible dependent status: Change in the eligibility of a dependent due to reaching a limiting age, change in student status or any similar circumstance; and
e) Residence: Change in the place of residence of the employee or the employee's dependent provided that the change in place of residence affects the eligibility for the employee or the employee's dependent's coverage under the group policy/plan
Consistency Rule: In all cases, any election change as a result of any change in status must be on account of and correspond with a change in status that affects eligibility for coverage under the plan. For example, if the change in status is the employee's divorce, the death of a spouse, an employee's election to cancel health coverage will apply only to the spouse involved
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Medicare Entitlement
Medicare Entitlement
Employees that have become entitled to or lose their Medicare or Medicaid may be eligible to make benefit changes.
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Entitlement to or loss of eligibility for Medicare or Medicaid: If an employee or the employee's dependent becomes entitled to or loses eligibility for Medicare (Part A or Part B) or Medicaid they may be able to make changes to their benefit plans.
Contact your Human Resources Department to confirm eligibility and determine what can be changed based on your specific situation.
Changes must be reported within 30 days of the eligibility change. You may add or drop medical, dental, or vision coverage for yourself or the applicable family member. You may also elect to change your medical FSA amount. You will need to complete the appropriate forms and provide a copy of the notification letter from Medicare or Medicaid.
Social Security/Retirement
For more information please visit the websites below.
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Dependent Audit & Spouse COB Certification
Plansource
To provide quality benefits while managing costs, dependent verification is important! Plansource, previously known as Next Generation, is a professional benefit-consulting group specializing in dependent eligibility verification.
When adding a dependent to the plan, you will receive a Dependent Eligibility Verification packet from Plansource requesting you to provide documentation such as a copy of marriage certificate or recent federal tax return and birth certificates along with a completed remittance form.
Spousal Coordination of Benefits – Eligibility Certification
If an employee’s spouse is eligible to participate in their employer’s group health insurance and/or prescription drug insurance, the spouse of the employee MUST enroll with at least single coverage in said employer’s sponsored group insurance coverage(s). If a spouse is self-employed and offers a group health and/or prescription drug plan to his/her employees, such self-employed spouse MUST also enroll with at least single coverage in such employer-sponsored group insurance.
This requirement does not apply to any spouse who must pay more than 50% of the spouse’s employers’ monthly single premium.
Upon the spouse’s enrollment in any such spouse available group health and/or prescription drug insurance coverage, that coverage will become the primary payer of benefits, and the coverage sponsored by ACSHP will become the secondary payer of benefits according to the primary plan’s Coordination of Benefits and participation rules.
It is the employee’s responsibility to advise the ACSHP (the “Plan”) immediately (and not later than 30 days after any change in eligibility) if the employee’s spouse becomes eligible to participate in group health insurance and/or prescription drug insurance sponsored by his/her employer. Upon becoming eligible, the employee’s spouse must enroll in any group health insurance and/or prescription drug insurance sponsored by his/her employer, unless he/she is exempt from this requirement in accordance with the exemptions stated above.
Every employee whose spouse participates in ACSHP group health insurance coverage and/or prescription drug insurance coverage shall complete and submit to the District’s Treasurer, upon request, a written certification verifying whether his/her spouse is eligible to participate in group health insurance coverage and/or prescription drug insurance coverage sponsored by the spouse’s employer. If any employee fails to complete and submit the certification form, such employee’s spouse may be terminated from the ACSHP health and prescription drug plan.
PLEASE NOTE: Retired Spouses WITH access to Employer-Sponsored Coverage – spouses MUST enroll in their former employer-sponsored health and/or prescription drug plans unless Medicare eligible.
If You and Your Spouse both work for an ACSHP School District, this provision does not apply to you.
ANNUAL SPOUSAL COB ELIGIBILITY RE-CERTIFICATION
The Allen County Schools Health Plan (ACSHP) Spousal Coordination of Benefits (COB) language stipulates an annual re-certification is required for spouses covered as Primary under the ACSHP health plan. PlanSource will conduct this recertification every December. They will certify if your spouse will remain covered as Primary, change to Secondary, or terminate coverage under the ACSHP health plan if the required information is not returned by the deadline.
If you have questions, contact Plansource from 8 a.m. to 11 p.m. EST Monday-Friday.
Phone Number: 888.266.1732