Benefit Changes

Generally, you cannot change your benefit elections during the year unless you experience a qualifying life event.

  • Examples of QLE: marriage, divorce, birth, adoption or a gain or loss of coverage by your spouse or dependent child.
  • Your change must be consistent with the Qualified Life Event which has occurred.
  • You will be required to furnish documentation of the change within 30 days of the event via PlanSource.

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Qualifying Life Events

Mid-Year Changes / Life Event Documentation

You may make changes to your benefits elections if you experience a qualified life event.

All changes must be submitted within 30 days and must be the result of and consistent with the qualified life event that occurred.

Submit Mid-Year Changes / Life Events

Life Event (Adding)

Action
Requirements
Adoption
Adoption records
Birth
Birth Certificate, or Hospital footprint record, or Hospital record
Marriage
Marriage Certificate
Gain custody of Dependent
Court Order documents
Self/Spouse/ Dependent Loses Coverage
Letter (on letterhead) from employer showing date coverage ended, or Online Benefit Confirmation Statement showing date coverage ended, AND required documents listed in "Who You Can Cover."
Lose Eligibility Medicare/ Medicaid
Letter from Center of Medicare and Medicaid Services (CMS) showing date coverage ended, AND required documents listed in "Who You Can Cover."
Spousal Surcharge
When your spouse becomes eligible for coverage through their employer, you are required to report this event and pay a spousal surcharge in order to keep your spouse covered on the medical plan.

Life Event (Removing)

Action
Requirements
Self/ Spouse/ Dependent Gains Coverage
Letter (on letterhead) from employer showing date coverage started, or Online Benefit Confirmation Statement showing date coverage started.
Gain Eligibility Medicare/Medicaid
Copy of Medicare or Medicaid card
Spousal Surcharge
When your spouse loses eligibility from coverage through their employer, you can report this event and remove the spousal surcharge, keeping your spouse covered on the medical plan.
Death of Dependent
Death Certificate (Long form)
Divorce
First page and Judges Signature page of Dissolution document/ Divorce Decree

Manage your benefits on PlanSource

Go To PlanSource

This Digital Benefits Guide only summarizes your benefit plans. If there is a discrepancy between the information in this document and the carrier plan document, the carrier plan documents will always govern.