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Qualifying Mid-Year Events

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Enrollment Deadlines

Certain qualifying mid-year events (QME) permit specific election changes outside the Open Enrollment period, including changes to your plan and membership. Examples of qualifying mid-year events include changes in your employment, changes in your marital status, changes in the number of your eligible family members, and changes affecting the employment of a covered family member. A complete list of QMEs may be found HERE. Your change request must be received within 60 calendar days of the event and be on account of and consistent with the event.

  •  The 60-day countdown period begins on the day of the event.
  •  Normally, the change will be effective the first of the month after the election change request is received.

There are two exceptions -

  • - HIPAA Special Enrollment due to birth, adoption and placement for adoption will allow for a retroactive effective date to enroll or make changes to the health plan coverage, and
  • - Terminations required by the plan due to loss of eligibility include events such as divorce, or when a child loses eligibility. In cases where there is a loss of dependent eligibility, the effective date of the change is based on the date of the event.

Once you have submitted a valid election during this enrollment window and that election takes effect, it is binding and may not be changed. You will be asked to provide supporting documentation for the qualifying mid-year event. When adding dependents to coverage, supporting documentation is required that provides proof of eligibility. If you do not have the documentation, do not miss the enrollment deadline. The documents can be submitted later. Contact your Benefits Specialist for help or more information.


REMEMBER:

  • A valid election, once submitted, is binding and may not be changed after it takes effect.
  • In general, Internal Revenue Service (IRS) rules require that your election change be consistent with the event.
  • Supporting documentation for dependent eligibility and qualifying mid-year events must be received before the request is approved.


HIPAA Special Enrollment

If you are declining enrollment for yourself or your dependents (including your spouse) because of other health insurance or group health plan coverage, under a HIPAA Special Enrollment you may be able to enroll yourself and your dependents in this plan if:

  •  you or your dependents lose eligibility for that other coverage (or if the employer stopped contributing towards your or your dependents' other coverage). However, you must request enrollment within 60 days of the date your or your dependents' other coverage ends (or after the employer stops contributing toward the other coverage).
  •  you have a new dependent as a result of marriage, birth, adoption, or placement for adoption, you may be able to enroll yourself and all eligible dependents. However, you must request enrollment within 60 days of the marriage, birth, adoption or placement for adoption.
  •  you or your dependent lose coverage in Medicaid or the State Children's Health Insurance Program (SCHIP) and you request coverage under the plan within 60 days of the time your coverage ends; or
  •  you or your dependent become eligible for a Medicaid or SCHIP premium assistance subsidy and you request coverage under the plan within 60 days of the date of your eligibility is determined.

To request a HIPAA Special Enrollment or obtain more information, contact your agency Benefits Administrator.