What is a Qualifying Event?
The following "life-changing events" are recognized as legitimate reasons for making a change to group health plans:
- Marriage or divorce
- Birth or adoption of a child
- Dependent no longer eligible (due to age, full independence, or marriage)
- Death of spouse or other dependent
- Spouse's employment begins or ends
- You or your spouse have a change in hours affecting your benefits eligibility
- Relocation into or outside of your plan's service area
- Beginning or end of an unpaid leave of absence taken by you or your spouse
Mid year changes to the following benefits plans are permitted ONLY if you have experienced one of the above qualifying events:
- Flexible Spending Accounts (Medical or Dependent Care)
- Health plan
- Dental plan
- Vision plan
Please Note: Appropriate documentation is required for ANY requested change.
What events are not considered Qualifying Events?
You would not be allowed to make a mid-year change to your benefits plan due to the following reasons:
- You have decided that you don't like the plan you elected
- Your doctor has dropped out of the network
- You did not realize when you enrolled that your doctor is not a network provider
- You can't afford it – unless Lee County has raised your premium at mid-year
- A child not on the plan moves home with you (there must be a loss of insurance)
- Your spouse has had a mid-year increase in premiums and our plan is now cheaper
Changes for these reasons must wait for Open Enrollment.
I just got married. Can I add my spouse and/or dependent(s) to my plans?
Yes, but ONLY to the plans in which you are currently enrolled yourself. You may not elect new plans such as Dental, Vision, or Optional Life Insurance for your new dependents/spouse if you do not already have them for yourself.
I just got married. How long do I have to add my spouse and/or dependent(s) to my plan(s)?
You have 60 days from the date of your marriage to add your spouse and/or dependents to your plan. If the 60 days have expired, you must wait until the next Open Enrollment period to add them. Open Enrollment normally occurs mid-October through the first week of November each year. The benefits would become effective on January 1st of the following plan year.
How do I add my spouse and/or eligible dependent(s) to my insurance plan(s)?
Provide the following documents:
- Enrollment Form(s)
- Enrollment/Change Form
- Optional Life Enrollment Form
- A copy of the ORIGINAL marriage certificate – If you are adding a Spouse to your plan(s)
- Social Security card – Spouse & Dependents
- Birth Certificate – Spouse & Dependents (Spouse only can provide Driver's License in lieu of Birth Certificate)
Separate Enrollment Forms must be completed to enroll your spouse and/or dependents in any of the plans.
Please Note: Your spouse and/or new dependents will NOT be added to the benefits plans WITHOUT the documentation.
I just got married and added my spouse and/or eligible dependent(s) to my plan. When will the coverage become effective?
Coverage will be effective the 1st of the month following the date of the event. Please Note: We CANNOT change the effective date even if you wait the full 60 days to add your spouse and dependents. Payroll adjustments will be made to cover the premiums missed for those first two months.
I am getting a divorce. How do I drop my ex-spouse from my plan(s)?
The divorced spouse is no longer an eligible dependent and MUST be dropped from your benefits plans.
Within 60 days of the divorce you must complete and submit the following documents:
- Enrollment/Change form
- Copy of the first & last pages of your final divorce decree
Your ex-spouse's coverage ends the last day of the month in which the divorce is finalized. Ex-spouses are offered COBRA for 36 months. You CANNOT drop a spouse mid-year if the divorce has not been finalized.
Please Note: It is fraudulent to keep a divorced spouse on the benefits plan. Any claims incurred after the end date of coverage will be reversed and your or your ex-spouse will be required to pay FULL charges for those services rendered.
What will happen if I notify Human Resources of an ineligible spouse or dependent after the 60 day qualifying event period widow?
The spouse and/or dependent will be dropped from your plan(s) the last day of the month in which the qualifying event took place. However, you will continue to pay the higher premium until the end of the calendar year in which the qualifying event took place.
I'm having a baby. How do I add my baby to my medical plan?
The following documents are required to add your baby to your plan:
- Enrollment/Change form
- Copy of Baby's Birth Certificate
- Copy of Baby's Social Security Card
Before your baby is born, you may complete the enrollment/change form. It will be held in the file until the birth of the baby. When your baby is born, call us with the baby's name, gender, and date of birth. You have up to 60 days to submit the accompanying required documentation (i.e. SS card, Birth Certificate). You should enroll your baby as soon as possible after birth in order to avoid any claims issues.
Please Note: Your baby should be enrolled regardless of whether or not you have the required documents.
Can my grandchild be covered under my health plan? If so, what do I need to do?
Grandchildren may be added for a period of 18 months of coverage provided that they are born to your dependent that is covered on your plan at the time of birth.
Refer to the previous question – link to question on adding a baby to the medical plan to see what forms and documents you will need. You must also complete the Affidavit of Grandchild Eligibility upon enrollment of your grandchild.
Can I add other family members (e.g. niece, nephew, mother-in-law) as dependents to my plan(s)?
No. We can only cover other dependents if there is court-ordered guardianship/custody. Our plan does not cover any adult dependents other than the legal spouse. Adult dependents that you claim on your federal income tax return are not eligible for coverage under our plan. Exception: Documented permanently disabled children who were covered on your plans prior to the date they turned 26 years old.