Qualifying Events for Changing Benefits

Because your premiums for medical, dental and vision are deducted from your salary on a pre-tax basis, the IRS has established strict rules regarding the operation of your plans. The choices made by you during the annual open enrollment period must remain in effect for the entire plan year (January 1 – December 31). Exceptions are permitted under IRS rules when a member has a qualifying event. If you have an event, you are required to notify Human Resources Benefits office within 31 days and complete the appropriate forms. Some examples of qualifying events include:

  • Change in marital status
  • Birth or adoption of a child
  • Death of a covered dependent
  • Loss of eligibility status by a covered dependent
  • Change in employment status that affects eligibility for coverage
  • Losing or gaining healthcare coverage eligibility under Medicare or Medicaid
  • Change in residence to a location outside of a healthcare plan’s service area

Consistency Rules

In order for a change in status to qualify for a midyear election change, the change in status must be “on account of,” and must correspond to, a change in status that affects the eligibility of an employee, spouse, or dependent for coverage under an employer’s plan. This change in status includes only a change that would make an individual eligible or ineligible for a particular benefit package option under the plan. The regulations do not permit midyear election changes for family members who are not affected by the change in status, such as unaffected children in the case of a divorce or death of a spouse.