Since the implementation of the Affordable Care Act, changes have been made to the list of qualifying events in order to make it easier for employees to change insurance before their next open enrollment period.
Employees are now allowed to enroll, cancel, or change plan options under any of the following circumstances:
- Loss of eligibility for group health benefits, individual health benefits, CHIP, or Medicaid
- Meeting eligibility requirements for state premium assistance, Medicaid, or CHIP subsidies
- Adding spouse or dependents through marriage, birth, adoption, or placement for adoption
- Death of spouse or dependent
- In the case of the birth of a child, a spouse can be enrolled due to the birth even if the spouse was not previously covered under the plan
- Change in marital status (marriage or divorce)
- Change in number of dependents
- Change in employment status (part-time to full-time or vice versa)
- Change in residence
- Change in cost of coverage that permits the employer to automatically increase or decrease employee contributions
- A significant change in the cost of coverage that permits an employee to add or drop coverage or switch plans
- A significant reduction of benefits with or without a loss of coverage
- If a plan adds a new benefit package or coverage option, improves an existing option, adds coverage for a new option, or switches plans
- Allows for new election or cancelling of coverage when a change is made under another employer plan (i.e. for spouse or dependent)
- Legal separation, annulment, or child support judgment
- Employee, spouse, or dependent become eligible for Medicare Part A or B, Medicaid or loses coverage under these plans
- Employee taking FMLA may revoke their election for insurance and choose another option for the remaining period of leave
Human resources must be notified of these changes within 31 days of the occurrence. Written proof of the event also needs to be submitted.
eni’s BalanceCare Guides are available to assist our members with questions regarding qualifying events. Learn more today!
*IRS Section 125