Qualifying Life Event
Qualifying Life Event
A qualifying life event is an event deemed acceptable by the IRS that may allow participants to change their benefit elections.
Timeframes:
You may change your benefit elections during the annual Open Enrollment period or during the year if you experience a Qualifying Life Event.
You may change your benefit elections during the annual Open Enrollment period or during the year if you experience a Qualifying Life Event.
A Qualifying Life Event change permits employees to make certain mid-year benefit changes consistent with the qualifying event by completing a Life Event Declaration Form and Life Event Enrollment within 60 days of the qualifying event date.
You must provide supporting documentation confirming the effective date of the change, listing all coverage being gained or lost and listing all covered individuals when requesting a mid-year benefit change. If you have any eligibility or enrollment questions, including what supporting documentation to provide for a life event, please contact the Benefits Team at (206) 439-5500.
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Qualifying Life Events:
1. Changes in status events, which include the following:
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Legal marital status: Change in the employee's legal marital status, including marriage, death of spouse, divorce, legal separation and annulment
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Number of dependents: Change in the employee's number of dependents, including birth, death, adoption and placement for adoption or legal guardianship
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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 resulting in the individual becoming or ceasing to be eligible under the group policy/plan
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Eligible dependent status: Change in the eligibility of a dependent due to reaching a limiting age. Coverage for dependents automatically ends on the last day of the month during which they turn 26 years old. No Life Event Declaration Form is needed for a dependent aging out of our Plan.
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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.
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: An Order or Decree resulting from a divorce, legal separation, annulment, or change in legal custody (including a qualified child support order) that requires healthcare coverage for an employee's children or step-children. 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.
Marriage
Marriage
Deciding to get married is a major life step and one that is worthy of sincere congratulations! Once you are married, you may add your spouse and any eligible step-children to your existing medical, dental, or vision coverage or waive your employer provided coverage to enroll on your spouse’s plan.
Healthcare Plan coverage for your new dependent(s) will become effective on the 1st of the month following the date of marriage or, if waiving, coverage ends on the last day of the month following the date of marriage. You may also elect to change your FSA Healthcare and Dependent Care amount(s).
You will need to complete your Life Event Declaration Form and Life Event Enrollment within 60 days of the qualifying event date.
You should also review your beneficiary designations for life insurance, retirement savings, and pension plans.
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Having a Baby or Adoption of a child
Having a Baby or Adoption of a child
The birth or adoption of a child is a life-changing event for families and it can bring immense joy to parents and children.
Having a Baby or Adoption 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 employer provided coverage to enroll on your spouse’s plan.
Having a Baby or Adoption 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 employer provided coverage to enroll on your spouse’s plan.
You may elect to change your FSA Healthcare amount and start or change a FSA Dependent Care election.
You will need to complete your Life Event Declaration Form and Life Event Enrollment within 60 days of the birth, adoption placement/final decree or court order.
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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 benefits coverage.
The following events will allow for a change in benefits coverage:
1. Spouse’s employer coverage is causing gain or loss of coverage
2. Spouse changes coverage during their employer’s Open Enrollment
You may elect medical, dental, or vision coverage, or waive your employer provided coverage to enroll on your spouse’s plan. You may also elect to change your FSA Healthcare and Dependent Care amount(s). You will need to complete your Life Event Declaration Form and Life Event Enrollment within 60 days of the qualifying event date.
Separation and Divorce
Separation and Divorce
Ending a relationship usually involves questions about the division of property and often the custody of children and their healthcare coverage.
Within 60 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, but continue to cover your children. You may also elect to change your FSA Healthcare and Dependent Care amount(s).
You will need to complete completing your Life Event Declaration Form and Life Event Enrollment within 60 days from the qualifying event date.
Prior to the final decree, you may not drop a spouse in anticipation of the final decree.
Remove Spouse from Benefits If your spouse is no longer eligible for coverage, you should complete a Life Event Declaration Form to remove them from the healthcare plans. Any step-children who are no longer eligible will also need to be removed from the plans.
Conversely, if you and / or your children were covered by your spouse's plan, you will need to enroll yourself or your child(ren) in the appropriate plan(s).
Review / Change Beneficiaries Review and / or make any changes to your beneficiary information for all of your plans.
Emergency Contact Information You may want to ensure your Human Resources Department is updated with person you want to be notified should your employer need to contact someone on your behalf in an emergency.
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Qualified Medical Support Order
Qualified Medical Support Order
A medical support order is designed to provide health coverage to a child(ren) of an employee through his or her employer's group health plan.
Qualified Medical Child Support Order (QMCSO)
A QMCSO is designed to provide health coverage to a child(ren) of an employee through his or her employer's group health plan. The QMCSO process occurs through the court system. A medical child support order becomes qualified as a QMCSO if it satisfies the employer's legal and administrative qualification requirements.
National Medical Support Notice (NMSN) provides health coverage for children through a group health plan, the process in reaching this objective differs. A medical child support order is a court order and must be signed by a judge before being submitted for qualification as a QMCSO. The NMSN process, meanwhile, primarily involves a state child support enforcement agency representing the interests of the children and submitting the notice for qualification.
Medicare Entitlement
Medicare Entitlement
Employees that have become entitled to or lose their Medicare or Medicaid may be eligible to make healthcare changes.
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.
Changes must be reported within 60 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 FSA Healthcare amount.
You will need to complete your Life Event Declaration Form and Life Event Enrollment within 60 days of the qualifying event date and provide a copy of the notification letter from Medicare or Medicaid for supporting documentation.
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The Loss of a Loved One
The 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.
You'll need to review your loved one's papers as well as their benefits package. Within 60 days of the death, you may elect any medical coverage you are losing under your spouse’s plan. If you currently cover your deceased spouse, you must drop their coverage for medical, dental, or vision although you may continue to cover the rest of your family.
You may also elect to change your FSA Healthcare and Dependent Care amount(s). Again, you should review your beneficiary designations for life insurance, retirement savings, and pension plans. You will need to complete your Life Event Declaration Form and Life Event Enrollment within 60 days of the qualifying event date.
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