Changes to Your Health Care Benefits

Other than during the annual “open enrollment” period, you may not change your coverage unless you experience a “qualifying event”. If you are declining enrollment for you or your dependents (including your spouse) because of other group medical coverage, you may in the future be able to enroll yourself or your dependents in this plan, provided that you qualify for a “special enrollment.”

The following are events that qualify for a special enrollment.

  • Change in legal marital status, including marriage, divorce, legal separation, annulment and death of a spouse

  • Change in number of dependents, including birth, adoption, placement for adoption, or death of a dependent child

  • Change in employment status, including the start or termination of employment by you, your spouse, or your dependent child that affects eligibility for benefits

  • Change in work schedule, including an increase or decrease in hours of employment by you, your spouse, or your dependent child, including a switch between part-time and full-time employment that affects eligibility for benefits

  • Change in a child's dependent status, either newly satisfying the requirements for dependent child status or ceasing to satisfy them

  • Change in an individual's eligibility for Medicare or Medicaid

  • A court order resulting from a divorce, legal separation, annulment, or change in legal custody (including a Qualified Medical Child Support Order) requiring coverage for your child

  • An event that is a special enrollment event under HIPAA (the Health Insurance Portability and Accountability Act), including acquisition of a new dependent or spouse or loss of coverage under another health insurance policy or plan if the coverage is terminated because of:
    • Voluntary or involuntary termination of employment or reduction in hours of employment or death, divorce, or legal separation,
    • Termination of employer contributions toward the other coverage, OR if the other coverage was COBRA Continuation Coverage, exhaustion of the coverage

Two rules apply to making changes to your benefits during the year:

  • Any changes you make must be consistent with the change in status

AND

  • You must make the changes within 45 days of the date the event (marriage, birth, etc.) occurs.

 

When Your Benefits Commence

Coverage is effective the first of the month following the date of your qualifying event. 

When Your Benefits Terminate

Coverage for you and your dependents ends if you are terminated or if you do not pay the required contribution within 30 days of its being due. Coverage for a particular dependent will end when he/she no longer meets the definition of an eligible dependent. If terminated, your coverage will continue through the end of the month in which you are terminated. You may continue benefits during a family leave of absence according to federal guidelines and in conjunction with the County’s policy for a limited period of time after termination, or under your federal and state COBRA rights.


For assistance with your health benefits contact:
Heather Evans, Risk Management Technician heather.evans@edcgov.us  or RiskManagement@edcgov.us