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Qualifying Events

The IRS regulations for mid-year health insurance changes (i.e. outside of open enrollment period) restrict any changes to your plan or coverage unless you have a qualified “change in status.” The following are considered qualified changes in status by the IRS:

  • 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
  • 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 place of residence or worksite, including a change that affects the accessibility of network providers
  • Change in your health coverage or your spouse’s coverage attributable to your spouse’s employment
  • 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 or dependent foster 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 other 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 31 days of the date the event (marriage, birth, etc.) occurs.

Qualifying Event

Paperwork to Complete
(within 31 days of event)

Documentation to Submit

Marriage

Coverage Change Form
Marital Status Change Form (PDF)
Beneficiary Change Form (PDF) if applicable
Spouse Health Coverage Certification

Copy of Marriage Certificate
Spouse's Social Security Number

Divorce

Coverage Change Form
Marital Status Change Form
(PDF)
Voluntary Life Cancellation
if applicable

Divorce Decree

New Baby

Coverage Change Form

Copy of Birth Certificate
Child's Social Security Number

Adoption

Coverage Change Form

Copy of Certified Adoption papers
Child's Social Security Number

Spouse/Dependent Gains Other Coverage

Coverage Change Form

Proof of other health coverage

Spouse/Dependent Loses Other Coverage

Copy of marriage certificate and/or birth certificate

Death of Spouse/Dependent

Coverage Change Form
Beneficiary Change Form (PDF) if applicable
Voluntary Life Cancellation if applicable

Copy of obituary