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Changing Coverage During the Year

 

Under normal circumstances you cannot change your coverage until open enrollment or at a special enrollment designated by DAS or unless you experience a qualified life event, but only if you submit a completed enrollment form to your agency within 31 days of one of the following events.
  • After marriage, divorce, legal separation, or annulment. Coverage becomes effective the first day of the month following the month of application
  • Birth, adoption, or placement for adoption or taking custody of the child for purposes of adoption. Coverage begins on the date of the event
  • Commencement of employment by the employee, spouse or dependent. Coverage becomes effective the first day of the month following the month of application
  • Termination of state service, death of the employee or death of employee's spouse. Coverage terminates the end of the month of the event, or - if desired - the end of the month of the event. A change from family to single coverage, if desired, is effective the first of the month following the death of a spouse.
  • Reduction or increase in hours of employment by the employee (including layoff or reinstatement from layoff), spouse or dependent, including a switch between part time and full time, strike, lockout or commencement, return to work from an unpaid leave of absence or change in work site. Coverage becomes effective the first day of the month following the month of the event provided a completed Enrollment Form is submitted to your agency within 31 days of the event
  • Return to work through order of arbitration or settlement of a grievance, or any administrative body with authority to order the return to work of an employee
  • The employee’s dependent satisfies or fails to satisfy the definition of a dependent due to attainment of age, student status or any similar circumstance as provided in the health plan under which the employee receives coverage
  • If the plan receives a Qualified Medical Child Support order (QMED) pertaining to an employee’s dependent, the employee may elect to add or drop the child to the plan depending upon the requirement of the QMED
  • If an employee, spouse or dependent who is enrolled in a health plan becomes entitled to coverage (i.e., enrolled) under Medicare or Medicaid, other than coverage consisting solely of benefits under section 1928 of the Social Security Act (the program for distribution of pediatric vaccines)
  • If an employee, spouse or dependent is no longer entitled to coverage (i.e., enrolled) under Medicare or Medicaid
  • The employee no longer resides or no longer works in the service area of the employee’s current plan
Limited Enrollment Period
During years in which there is no open enrollment, a limited enrollment period will be designated by DAS. During this limited enrollment period, employees may:
  • Add or remove dependents
  • Increase their supplemental life insurance amount and
  • Enroll for health, dental, vision or supplemental life insurance benefits for the first time.

Leave of Absence
If you are on leave of absence and coverage has not stopped, you may apply for coverage or change of coverage during the period of open enrollment; however, no change will become effective until the first day of the month following your return to active work status. If you are on disability leave or are receiving benefits from workers’ compensation, changes you make during open enrollment will take effect at the beginning of the next benefit period.

If You Move
You may change health plans during the year if you move outside your HMO’s service area.

 

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DISABILITY AND LEAVE OF ABSENCE ->

 

 

 

A new Enrollment Form must be completed and submitted to your agency within 31 days of any of these qualified events.These forms are available from your payroll or personnel office.
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