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Life Events

Employee Benefits’ Life Event 

You can make changes to certain benefit elections during the year only if you experience a life event.  You can request changes that are consistent with your life event by making changes to your benefit elections within 30 days after the date of the event (60 days for birth and adoption for health and dental.)  Depending upon the life event, you may be required to submit documentation of the event.  If you do not make the changes in a timely manner, you will not be able to change your benefits until the next annual enrollment and change period.  Contact your Human Resources Associate for assistance in making timely changes.

Life Events

Change in Marital Status

Marriage

Health Insurance
  • You may enroll in coverage and/or add eligible family members.
  • You may change your health plan if you are adding eligible family members. 
  • You may cancel coverage if you become covered by your spouse’s health plan.  If eligible, you may elect the health insurance opt-out.
Dental Insurance
  • You may add your spouse and spouse’s eligible family members to your existing dental plan. 
  • You may cancel your coverage if you become covered by your spouse’s dental plan. 
Health FSA
  • You may enroll, increase, or decrease your contribution.
  • You may cancel your contribution if you become covered by your spouse’s health FSA plan.
Dependent Care FSA
  • You may enroll or increase your contribution if marriage increases dependent care expenses.
  • You may decrease contributions if the family elects dependent care assistance under spouse’s plan or marriage decreases dependent care expenses.
Supplemental Life Insurance
  • You may enroll or increase the amount of your coverage. Satisfactory evidence of insurability is required.
  • You may cancel or decrease the amount of your coverage.

Updated 06/2019 

Common Law Marriage

(You must complete the Affidavit of Common Law Marriage form.)

Health Insurance
  • You may enroll in coverage and/or add eligible family members.
  • You may change your health plan if you are adding eligible family members.
  • You may cancel coverage if you become covered by your spouse’s health plan. If eligible, you may elect the health insurance opt-out.
Dental Insurance
  • You may enroll in coverage and/or add eligible family members.
  • You may cancel your coverage if you become covered by your spouse’s dental plan. 
Health FSA
  • You may enroll, increase, or decrease your contribution.
  • You may cancel your contribution if you become covered by your spouse’s health FSA plan.
Dependent Care FSA
  • You may enroll or increase contribution if marriage increases dependent care expenses.
  • You may decrease contributions if the family elects dependent care assistance under spouse’s plan or marriage decreases dependent care expenses.
Supplemental Life Insurance
  • You may enroll or increase the amount of your coverage. Satisfactory evidence of insurability is required.
  • You may cancel or decrease the amount of your coverage.

Updated 06/2019 

Domestic Partnership

(You must complete the Affidavit of Domestic Partnership form.)

Health Insurance
  • You may enroll in coverage and/or add the domestic partner and eligible domestic partner’s family members.
  • You may change your health plan if you are adding eligible family members.  
  • You may cancel coverage if you become covered by your partner’s health plan. If eligible, you may elect the health insurance opt-out.
Dental Insurance
  • You may enroll in coverage and/or add the domestic partner and eligible domestic partner’s family members.
  • You may cancel your coverage if you become covered by your partner’s dental plan.
Health FSA
  • You may enroll or increase your contribution if your domestic partner and eligible domestic partner’s family members, if any, are tax dependents.
Dependent Care FSA
  • You may enroll or increase contribution if your domestic partner and eligible domestic partner's family members, if any, are tax dependents. 
  • You may decrease contributions if your dependent care expenses decrease.
Supplemental Life Insurance
  • If the Domestic Partner is a tax dependent, you may enroll or increase the amount of your coverage. Satisfactory evidence of insurability is required.
  • If the Domestic Partner is a tax dependent, you may cancel or decrease the amount of your coverage.
  • If the Domestic Partner is not a tax dependent, no change allowed.

Updated 06/2019 

Divorce, Legal Separation, Annulment

* Only allows removal of spouse from health and dental coverage.

Health Insurance
  • You must remove your former spouse and former spouse’s eligible family members from coverage. 
  • You cannot remove other dependents from coverage unless they are added to your former spouse’s plan. 
  • You may enroll yourself in coverage and add dependents if the event causes loss of coverage under former spouse’s plan.
  • You may change your health plan if you are adding dependents that lost coverage under your former spouse’s plan.
Dental Insurance
  • You must remove your former spouse and former spouse’s eligible family members from coverage.
  • You cannot remove other dependents from coverage unless they are added to your former spouse’s plan.  
  • You may enroll yourself in coverage and add dependents if the event causes loss of coverage under former spouse’s plan.
Health FSA
  • You may decrease your contribution to reflect loss of your spouse’s eligibility. 
  • You may enroll or increase your contribution if coverage is lost under your spouse’s health or health FSA plan. 
Dependent Care FSA
  • You may enroll or increase contributions if event increases dependent care expenses or causes loss of coverage under spouse’s plan.
  • You may decrease contributions if event decreases dependent care expenses.
Supplemental Life Insurance
  • You may enroll or increase the amount of your coverage. Satisfactory evidence of insurability is required.  
  • You may cancel or decrease the amount of your coverage.

Updated 06/2019 

Termination of Domestic Partnership

(You must complete the Affidavit of Termination of Domestic Partnership form.)

Health Insurance
  • You must remove your former domestic partner and domestic partner’s eligible family members from coverage.
Dental Insurance
  • You must remove your former domestic partner and domestic partner’s eligible family members from coverage.
Health FSA
  • You may decrease your contribution to reflect loss of your domestic partner and domestic partner’s eligible family members as long as they are tax dependents.
Dependent Care FSA
  • You may decrease your contribution if event decreases dependent care expenses for domestic partner’s eligible family members as long as they are tax dependents.
Supplemental Life Insurance
  • You may enroll or increase the amount of your coverage.  Satisfactory evidence of insurability is required.  
  • You may cancel or decrease the amount of your coverage.

Updated 06/2019 

Death of Spouse

Health Insurance
  • You will remove your spouse from coverage. 
  • You may enroll in coverage or add your children that lost coverage under your deceased spouse’s plan.
  • You may change your health plan if you are adding your children that lost coverage under the deceased spouse’s plan.
Dental Insurance
  • You will remove your spouse from coverage. 
  • You may enroll in coverage or add your children that lost coverage under the deceased spouse’s plan.
Health FSA
  • You may decrease your contribution to reflect loss of your spouse. 
  • You may enroll or increase your contribution if coverage is lost under your deceased spouse’s plan. 
Dependent Care FSA
  • You may increase contributions if event increases dependent care expenses or causes loss of coverage under your deceased spouse’s plan.
Supplemental Life Insurance
  • You may enroll or increase the amount of your coverage. Satisfactory evidence of insurability is required.  
  • You can cancel or decrease the amount of your coverage.

Updated 06/2019 

Death of Domestic Partner

(You must complete the Affidavit of Termination of Domestic Partnership form.)

Health Insurance
  • You will remove your domestic partner from coverage. 
  • Domestic partner child(ren) must be removed.
  • You may enroll in coverage or add your children that lost coverage under your deceased domestic partner’s plan.
  • You may change your health plan if you are adding your children that lost coverage under the deceased domestic partner’s plan.
Dental Insurance
  • You will remove your domestic partner from coverage. 
  • Domestic partner child(ren) must be removed.
  • You may enroll in coverage or add your children that lost coverage under your deceased domestic partner’s plan.
Health FSA
  • You may decrease your contribution to reflect loss of your domestic partner and domestic partner's eligible family members as long as they are tax dependents as of the date of the event.
Dependent Care FSA
  • You may increase or decrease contributions if event increases or decreases dependent care expenses or causes loss of coverage under your domestic partner's plan.  
Supplemental Life Insurance
  • If the Domestic Partner is a tax dependent, you may enroll or increase the amount of your coverage.  Satisfactory evidence of insurability is required.  
  • If the Domestic Partner is a tax dependent, you may cancel or decrease the amount of your coverage.

 

Updated 06/2019

 

Change in the Number of Your Dependents

Adoption, Birth, Placement for Adoption, Placement of a Foster Child

Health Insurance
  • You may enroll yourself or add newly eligible dependent, spouse, and other dependents. 
  • You may also change your health plan if you are adding eligible family members. 
  • You may cancel coverage if you become covered by your spouse’s health plan.  If eligible, you may elect the health insurance opt-out.
Dental Insurance
  • You may enroll yourself or add newly eligible dependent, spouse, and other dependents. 
  • You may cancel your coverage if you become covered by your spouse’s dental plan.
Health FSA
  • You may enroll to contribute, continue your contribution, or increase your contribution.
Dependent Care FSA
  • You may enroll to contribute, continue contributions, or increase your contribution if the event increases dependent care expenses.
Supplemental Life Insurance
  • You may enroll or increase the amount of your coverage. Satisfactory evidence of insurability is required.  
  • You may cancel or decrease the amount of your coverage.

Updated 06/2019 

Addition of a Domestic Partner’s Eligible Dependent

Health Insurance
  • You may add the newly eligible domestic partner’s dependent. 
  • You may also change your health plan.
Dental Insurance
  • You may add the newly eligible domestic partner’s dependent.
Health FSA
  • You may enroll or increase your contribution if your domestic partner and eligible domestic partner’s family members are tax dependents.
Dependent Care FSA
  • You may enroll or increase your contribution if the eligible domestic partner’s family members are tax dependents.
Supplemental Life Insurance
  • If the Domestic Partner's dependent is the employee's tax dependent, you may enroll or increase the amount of your coverage.  Satisfactory evidence of insurability is required.

Updated 06/2019 

Dependent No Longer Eligible Because of Age, Student Status, or Marital Status

Health Insurance
  • You may only cancel coverage for dependent no longer eligible. 
Dental Insurance
  • You may only cancel coverage for dependent no longer eligible.
Health FSA
  • You may decrease or cancel contribution. 
Dependent Care FSA
  • No changed is allowed.
Supplemental Life Insurance
  • You may enroll or increase the amount of your coverage. Satisfactory evidence of insurability is required.
  • You may cancel or decrease the amount of your coverage.

Updated 06/2019 

Domestic Partner’s Dependent No Longer Eligible Because of Age, Student Status, or Marital Status

( You must complete the Domestic Partnership: Cancellation of Health and Dental Coverage form.)

Health Insurance
  • You may only cancel coverage for dependent that is no longer eligible. 
Dental Insurance
  • You may only cancel coverage for dependent that is no longer eligible. 
Health FSA
  • You may decrease or cancel contribution.
Dependent Care FSA
  • You may decrease or cease the election if the dependent reaches the age of 13 or becomes capable of self-care, if the domestic partner and dependent are tax dependents.
Supplemental Life Insurance
  • If the Domestic Partner's dependent is the employee's tax dependent, you may enroll or increase the amount of your coverage. Satisfactory evidence of insurability is required.
  • You may cancel or decrease the amount of your coverage.

Updated 06/2019 

Dependent Eligible Again by Becoming a Full-Time Student

Health Insurance
  • You may enroll the newly eligible dependent.  
Dental Insurance
  • You may enroll the newly eligible dependent. 
Health FSA
  • No change is allowed.
Dependent Care FSA
  • No change is allowed.
Supplemental Life Insurance
  • You may enroll or increase the amount of your coverage. Satisfactory evidence of insurability is required.
  • You may cancel or decrease the amount of your coverage.
     

Updated 06/2019 

Domestic Partner’s Dependent Eligible Again by Becoming a Full-Time Student

 

Health Insurance
Dental Insurance
Health FSA
  • No change is allowed.
Dependent Care FSA
  • No change is allowed.
Supplemental Life Insurance
  • If the Domestic Partner's dependent is the employee's tax dependent, you may enroll or increase the amount of your coverage. Satisfactory evidence of insurability is required.
  • You may cancel or decrease the amount of your coverage.

Updated 06/2019 

Death of Any Covered Member

Health Insurance
  • You may only cancel coverage for the deceased member.  
Dental Insurance
  • You may only cancel coverage for the deceased member.  
Health FSA
  • You may decrease contribution or cancel contribution. 
Dependent Care FSA
  • You may decrease contribution or cancel contribution if you have reduced dependent care expenses.
Supplemental Life Insurance
  • You may enroll or increase the amount of your coverage. Satisfactory evidence of insurability is required.  
  • You may cancel or decrease the amount of your coverage.

Updated 06/2019 

Change in Your Employment Status

Promotion, Demotion, Transfer, or Reclassification Resulting in a Change in Bargaining Status

Health Insurance
  • You may change your health plan only if your current health plan is not offered as a result of the change in bargaining status or elect the health insurance opt-out.
  • You may cancel coverage.  
  • If eligible, you may elect the health insurance opt-out.
Dental Insurance
  • You may cancel coverage. 
Health FSA
  • No change is allowed.
Dependent Care FSA
  • No change is allowed.
Supplemental Life Insurance
  • You may increase or decrease coverage if the benefits are different between the bargaining classes. 
  • If increasing coverage, satisfactory evidence of insurability is required.

Updated 06/2019 

Promotion, Demotion, Transfer, or Reclassification with NO Change in Bargaining Status

Health Insurance
  • No change is allowed.
Dental Insurance
  • No change is allowed.
Health FSA
  • No change is allowed.
Dependent Care FSA
  • No change is allowed.
Supplemental Life Insurance
  • No change is allowed.

Updated 06/2019 

Loss of Employee’s Coverage

Health Insurance
  • Coverage for you and eligible family members ceases at the end of the month in which coverage is lost.
  • You may pay for continued coverage through COBRA for up to 18 months, if not eligible for Medicare.
Dental Insurance
  • Coverage for you and eligible family members ceases at the end of the month in which coverage is lost.
  • You may pay for continued coverage through COBRA for up to 18 months.
Health FSA
  • Contributions cease. You can continue to submit claims but only for expenses incurred while you were an eligible employee.
  • You may continue participation on an after-tax basis through COBRA.
Dependent Care FSA
  • Contributions cease. You can continue to submit claims but only for expenses incurred while you were an eligible employee or while you are employed elsewhere or looking for employment. 
Supplemental Life Insurance
  • Your coverage ceases at the end of the month in which coverage is lost.
  • You may pay for continued coverage under the conversion  or portability provisions. 

Updated 06/2019 

Change in Scheduled Hours from 40 Hours per Week to 39 – 30 Hours per Week

Health Insurance
  • No change is allowed.
Dental Insurance
  • No change is allowed.
Health FSA
  • No change is allowed.
Dependent Care FSA
  • No change is allowed.
Supplemental Life Insurance
  • No change is allowed.

Updated 06/2019 

Full-time to Part-time

Permanent change in scheduled hours from 40 hours per week to 20 – 29 hours per week.

Health Insurance
  • If enrolled, you may cancel coverage.
  • If enrolled in family coverage, you may cancel eligible family members. 
  • You may change your health plan.
Dental Insurance
  • If enrolled, you may cancel coverage.
  • If enrolled in family coverage, you may cancel eligible family members. 
Health FSA
  • No change is allowed.
Dependent Care FSA
  • No change is allowed.
Supplemental Life Insurance
  • Your coverage ceases at the end of the month in which coverage is lost.
  • You may pay for continued coverage under the conversion or portability provisions.

Updated 06/2019 

Full-time to Not Benefit Eligible

Permanent change in scheduled hours from 40 hours per week to less than 20 per week (less than 30 hours for life insurance).

Health Insurance
  • Coverage for you and your dependents ceases at the end of the month.
  • ​You may pay for continued coverage through COBRA for up to 18 months, if not eligible for Medicare. 
Dental Insurance
  • Coverage for you and your dependents ceases at the end of the month.
  • You may pay for continued coverage through COBRA for up to 18 months. 
Health FSA
  • Contributions cease. You can continue to submit claims but only for expenses incurred while you were an eligible employee.
  • You may continue participation on an after-tax basis through COBRA, if eligible.
Dependent Care FSA
  • Contributions cease. 
Supplemental Life Insurance
  • Your coverage ceases at the end of the month.
  • You may pay for continued coverage under the conversion or portability provisions.

Updated 06/2019 

Not Benefit Eligible to Benefit Eligible

Change in scheduled hours from less than 20 hours per week to 20 – 40 hours per week (health, dental and FSA); 30 – 40 hours per week (life insurance).   

Health Insurance
  • You may enroll you and your eligible family members in coverage. 
Dental Insurance
  • You may enroll you and your eligible family members in coverage. 
Health FSA
  • You may enroll in coverage. 
Dependent Care FSA
  • You may enroll in coverage. 
Supplemental Life Insurance
  • You may enroll in coverage. 

Updated 06/2019 

Part-time to Full-time

Permanent change in scheduled hours from 20 – 29 hours per week to 30 – 40 hours per week. 

Health Insurance
  • You may enroll you and your eligible family members in coverage.
  • If eligible, you may elect the health insurance opt-out.
Dental Insurance
  • You may enroll you and your eligible family members in coverage.
Health FSA
  • No change is allowed.
Dependent Care FSA
  • No change is allowed.
Supplemental Life Insurance
  • You may enroll in coverage. 

Updated 06/2019 

Rehired Less than 30 Days after Termination of Employment

Health Insurance
  • Reinstate to prior plan election or you may make a new election similar to a new hire.
Dental Insurance
  • Reinstate to prior plan election or you may change your coverage level.
Health FSA
  • Reinstate prior contribution. 
Dependent Care FSA
  • Reinstate prior contribution. 
Supplemental Life Insurance
  • Reinstate prior contribution. 

Updated 06/2019 

Change in Your Spouse’s or Dependent’s Status

Spouse Terminates Employment

Health Insurance
  • You may enroll in coverage and/or add eligible family members if they lost coverage under the spouse’s plan.
  • You may change your health plan if you are adding dependents that lost coverage under your spouse’s former plan.
Dental Insurance
  • You may enroll in coverage and/or add eligible family members if they lost coverage under the spouse’s plan.
Health FSA
  • You may enroll or increase contribution if spouse’s termination adversely affects eligibility for coverage under spouse’s health or health care FSA plan.
Dependent Care FSA
  • You may enroll or increase coverage if you lost coverage under your spouse's FSA plan. You can also cancel coverage, or decrease contribution if your spouse’s termination decreases dependent care expenses.
Supplemental Life Insurance
  • You may enroll in or increase life coverage if your spouse is no longer employed which resulted in a loss of group life insurance. Satisfactory evidence of insurability is required.  
  • You may cancel or decrease the amount of your coverage.

Updated 06/2019

Spouse Commences Employment

Health Insurance
  • You may cancel coverage for you and/or eligible family members if you become covered by spouse’s health plan. 
  • If cancelling your coverage, you may elect the health insurance opt-out if eligible.
Dental Insurance
  • You may cancel coverage for you and/or eligible family members.
Health FSA
  • You may decrease contributions if spouse becomes covered under health or health care FSA plan.
Dependent Care FSA
  • You may enroll or increase contributions if event increases dependent care expenses. 
  • You may cease or decrease if you become eligible for spouse's FSA plan.
Supplemental Life Insurance
  • You may enroll or increase the amount of your coverage. Satisfactory evidence of insurability is required.
  • You may cancel or decrease the amount of your coverage.

Updated 06/2019

Dependent Commences Employment

Health Insurance
  • You may cancel coverage for the dependent commencing employment. 
Dental Insurance
  • You may cancel coverage for the dependent commencing employment.
Health FSA
  • You may decrease contributions if dependent becomes covered under health or health care FSA plan.
Dependent Care FSA
  • You may enroll or increase contributions if event increases dependent care expenses. 
Supplemental Life Insurance
  • You may enroll or increase the amount of your coverage. Satisfactory evidence of insurability is required.
  • You may cancel or decrease the amount of your coverage.

Updated 06/2019

Spouse’s Benefit Election Period Different from the State’s Benefit Election Period

Health Insurance
  • You may enroll yourself or add spouse and other eligible dependents. 
  • You may also change your health plan if you are adding eligible family members. 
  • You may cancel coverage if you become covered by your spouse’s health plan. If eligible, you may elect the health insurance opt-out.
Dental Insurance
  • You may enroll yourself or add spouse and other eligible dependents. 
  • You may cancel coverage if you become covered by your spouse’s dental plan.
Health FSA
  • No change is allowed.
Dependent Care FSA
  • No change is allowed.
Supplemental Life Insurance
  • No change is allowed.

Updated 06/2019

Other Change in Spouse’s Employment Status: Cease to Be Eligible

(Change in spouse’s employment status that causes spouse to cease to be eligible for coverage under spouse’s plan (e.g., switch from salaried to hourly status.))

Health Insurance
  • You may enroll in coverage and/or add eligible family members.
  • You may change your health  plan if you are adding dependents that lost coverage under your  spouse’s former plan.
Dental Insurance
  • You may enroll in coverage and/or add eligible family members if they lost coverage under the spouse’s plan.
Health FSA
  • You may enroll or increase contribution if spouse’s employment change adversely affects eligibility for coverage under spouse’s health or health care FSA plan.
Dependent Care FSA
  • You may enroll or increase contribution if spouse’s employment change increases dependent care expenses or causes a loss of eligibility for spouse's FSA plan.
  • You may decrease or cancel contribution if the event decreases dependent care expenses.
Supplemental Life Insurance
  • You may enroll or increase the amount of your coverage. Satisfactory evidence of insurability is required.
  • You may cancel or decrease the amount of your coverage.

 

Updated 06/2019

Other Change in Spouse’s Employment Status: Gain Eligibility

Change in spouse’s employment status to cause spouse to gain eligibility for coverage (e.g.., switch from hourly to salaried status). 

Health Insurance
  • You may cancel coverage for you and eligible family members if you become covered by spouse’s health plan.
  • If cancelling your coverage, you may elect the health insurance opt-out if eligible.
Dental Insurance
  • You may cancel coverage for you and eligible family members if you become covered by spouse’s dental plan.
Health FSA
  • Decrease or cease contribution if family becomes covered under health or health care FSA plans of spouse. 
Dependent Care FSA
  • Decrease or cease contribution if family becomes covered under spouse’s dependent care assistance plan.
Supplemental Life Insurance
  • You may enroll or increase the amount of your coverage. Satisfactory evidence of insurability is required.
  • You may cancel or decrease the amount of your coverage.

Updated 06/2019

Spouse Loses Health and/or Dental Coverage

(Change in spouse’s employment status that causes spouse to cease to be eligible for coverage under spouse’s plan (e.g.., switch from salaried to hourly status.))

Health Insurance
  • You may enroll in coverage and/or add eligible family members.
  • You may change your health  plan if you are adding dependents that lost coverage under your  spouse’s former plan.
Dental Insurance
  • You may enroll the spouse in coverage and/or add eligible family members if they lost coverage under the spouse's plan.
Health FSA
  • Enroll or increase contribution to the health FSA.
Dependent Care FSA
  • No change is allowed.
Supplemental Life Insurance
  • No change is allowed.

Updated 06/2019

Spouse Loses Eligibility for Creditable Health Coverage

*Creditable health coverage is defined in the Health Insurance Protection and Portability Act (HIPPA) as defined in 45 CFR §160.103.

Health Insurance
  • You may enroll the spouse in coverage and/or add eligible family members if they lost coverage under the spouse's plan.
  • You may change your health  plan if you are adding dependents that lost coverage under your  spouse’s former plan.
Dental Insurance
  • No change is allowed.
Health FSA
  • You may enroll or increase contribution to the health FSA.
Dependent Care FSA
  • No change is allowed.
Supplemental Life Insurance
  • No change is allowed.

Updated 06/2019

Spouse’s Employer or Group Sponsor Ceases Contribution to Creditable Health Coverage

*Creditable health coverage is defined in the Health Insurance Protection and Portability Act (HIPPA) as defined in 45 CFR §160.103.

Health Insurance
  • You may enroll in coverage and/or add eligible family members.
  • You may change your health  plan if you are adding dependents that lost coverage under your spouse’s former plan.

 

Dental Insurance
  • No change is allowed.

 

Health FSA
  • You may enroll or increase contribution to the health FSA.

 

Dependent Care FSA
  • No change is allowed.

 

Supplemental Life Insurance
  • No change is allowed.

Updated 06/2019

Dependent Loses Health and/or Dental Coverage

Health Insurance
  • You may enroll the eligible dependent in coverage.
  • You may change your health plan.
Dental Insurance
  • You may enroll the eligible dependent in coverage.
Health FSA
  • You may enroll or increase contribution to the health FSA.
Dependent Care FSA
  • No change is allowed.
Supplemental Life Insurance
  • No change is allowed.

Updated 06/2019 

Dependent Loses Eligibility for Creditable Health Coverage

*Creditable health coverage is defined in the Health Insurance Protection and Portability Act (HIPPA) as defined in 45 CFR §160.103.

Health Insurance
  • You may enroll the eligible dependent in coverage.
  • You may change your health plan.
Dental Insurance
  • No change is allowed.
Health FSA
  • You may enroll or increase contribution to the health FSA.
Dependent Care FSA
  • No change is allowed.
Supplemental Life Insurance
  • No change is allowed.

Updated 06/2019

Dependent’s Employer or Group Sponsor Ceases Contribution to Creditable Health Coverage

*Creditable health coverage is defined in the Health Insurance Protection and Portability Act (HIPPA) as defined in 45 CFR §160.103.

Health Insurance
  • You may enroll the eligible dependent in coverage.
  • You may change your health plan.
Dental Insurance
  • No change is allowed.
Health FSA
  • You may enroll or increase contribution to the health FSA.
Dependent Care FSA
  • No change is allowed.
Supplemental Life Insurance
  • No change is allowed.

Updated 06/2019

Eligible Dependent Discharged From Active Military Service

Health Insurance
  • You may add the eligible dependent.
Dental Insurance
  • You may add the eligible dependent.
Health FSA
  • You may enroll or increase contribution to the health FSA.
Dependent Care FSA
  • No change is allowed.
Supplemental Life Insurance
  • No change is allowed.

Updated 06/2019

Eligible Dependent Enrolling Full-Time in an Accredited Institution of Postsecondary Education

Health Insurance
  • You may add the eligible dependent.
Dental Insurance
  • You may add the eligible dependent.
Health FSA
  • You may enroll or increase contribution to the health FSA.
Dependent Care FSA
  • No change is allowed.
Supplemental Life Insurance
  • No change is allowed.

Updated 06/2019

Change in Residence of You, Your Spouse, or Your Dependent

Employee, Spouse, or Dependent Changes Residence and Becomes Ineligible under Employer’s Plan or for Current Benefit Option

Health Insurance
  • You may change your health plan.  
Dental Insurance
  • No change is allowed.
Health FSA
  • No change is allowed.
Dependent Care FSA
  • You may increase or decrease contribution only if child care provider changes. 
Supplemental Life Insurance
  • You may enroll or increase the amount of your coverage. Satisfactory evidence of insurability is required.
  • You may cancel or decrease the amount of your coverage.

Updated 06/2019

Employee, Spouse, or Dependent Changes Residence and Becomes Newly Eligible Under Employee’s Plan or for New Benefit Option

Health Insurance
  • You may change your health plan.  
Dental Insurance
  • No change is allowed.
Health FSA
  • No change is allowed.
Dependent Care FSA
  • You may increase or decrease contribution only if child care provider changes. 
Supplemental Life Insurance
  • You may enroll or increase the amount of your coverage. Satisfactory evidence of insurability is required.
  • You may cancel or decrease the amount of your coverage.

Updated 06/2019

Employee, Spouse, or Dependent Changes Residence and Becomes Ineligible Under Spouse’s Current Benefit Option or Plan

Health Insurance
  • You may enroll in coverage and/or add eligible family members if they lost coverage under the spouse's plan.
Dental Insurance
  • No change is allowed.
Health FSA
  • You may enroll or increase contribution if spouse’s employment change adversely affects eligibility for coverage under spouse’s health or health care FSA plan.
Dependent Care FSA
  • You may increase or decrease contribution only if child care provider changes. 
Supplemental Life Insurance
  • You may enroll or increase the amount of your coverage. Satisfactory evidence of insurability is required.
  • You may cancel or decrease the amount of your coverage.

Updated 06/2019

Employee, Spouse, or Dependent Changes Residence and Becomes Newly Eligible Under Spouse’s Plan or for New Benefit Option

Health Insurance
  • You may change your health plan or cancel coverage if other coverage is available.  
  • If cancelling your coverage, you may elect the health insurance opt-out if eligible.
Dental Insurance
  • No change is allowed.
Health FSA
  • You may decrease contribution if spouse or dependent becomes covered under health or FSA plan of spouse or dependent.
Dependent Care FSA
  • You may increase or decrease contribution only if child care provider changes.
Supplemental Life Insurance
  • You may enroll or increase the amount of your coverage. Satisfactory evidence of insurability is required.
  • You may cancel or decrease the amount of your coverage.

Updated 06/2019

Commencing or Returning from a Leave of Absence

Commence Unpaid Leave Less than 30 Days

Health Insurance
  • No change is allowed.
Dental Insurance
  • No change is allowed.
Health FSA
  • No change is allowed.
Dependent Care FSA
  • Coverage ceases during the leave. You may make a new annual election upon return to employment.
Supplemental Life Insurance
  • You may enroll, continue your coverage, or increase the amount of your coverage. If you enroll or increase your coverage, satisfactory evidence of insurability is required.
  • You may cancel or decrease the amount of your coverage.

Updated 06/2019

Commence Unpaid Leave In Excess Of 30 Consecutive Calendar Days

Health Insurance
  • You are billed for the total cost of any premiums due. Premiums are paid with after-tax dollars.  
  • You may change your health plan. 
  • You may cancel your coverage.
Dental Insurance
  • You are billed for the total cost of any premiums due. Premiums are paid with after-tax dollars.
  • You may cancel your coverage.
Health FSA
  • Contributions and coverage cease.
Dependent Care FSA
  • Contributions and coverage cease.
Supplemental Life Insurance
  • You may enroll, continue your coverage, or increase the amount of your coverage.  If you elect to continue coverage, you must pay supplemental life insurance premiums to your Human Resources Associate. If you enroll or increase your coverage, satisfactory evidence of insurability is required.
  • You may cancel or decrease your coverage.

Updated 06/2019 

Commence Unpaid FMLA Leave in Excess of 30 Consecutive Calendar Days

Health Insurance
  • You are billed for any premiums due at the same cost sharing agreement as active employees. Premiums are paid with after-tax dollars.
  • You may change your health plan.
  • You may cancel your coverage.
Dental Insurance
  • You are billed for any premiums due at the same cost sharing agreement as active employees. Premiums are paid with after-tax dollars.
  • You may cancel your coverage.
Health FSA
  • Contributions cease. You may continue to submit claims but only for expenses incurred while you were an eligible employee. 
  • If you wish to retain coverage, you may prepay  or  you may make payments on an after-tax basis.
     
Dependent Care FSA
  • Contributions cease.  You may continue to submit claims but only for expenses incurred while you were at work.
Supplemental Life Insurance
  • You may enroll, continue your coverage, or increase the amount of your coverage.  If you elect to continue coverage, you must pay supplemental life insurance premiums to your Human Resources Associate.  
  • If you enroll or increase your coverage, satisfactory evidence of insurability is required.
  • You may cancel or decrease your coverage.

Updated 06/2019

Return from Unpaid Leave or Unpaid FMLA in excess of 30 Consecutive Calendar Days

Health Insurance
  • Reinstate prior election.
  • You may change your health plan.
  • You may change your coverage level.
  • You may cancel coverage. If eligible, you may elect the health insurance opt-out.
Dental Insurance
  • Reinstate prior election.
  • You may cancel coverage. 
Health FSA
  • Reinstate prior contribution or make a new election.
Dependent Care FSA
  • Reinstate prior contribution or make a new election.
Supplemental Life Insurance
  • You may enroll, continue your coverage, or increase the amount of your coverage.  If you enroll or increase your coverage, satisfactory evidence of insurability is required.
  • You may cancel or decrease the amount of your coverage.

Updated 06/2019

Commence Paid Leave

Health Insurance
  • No change is allowed.
Dental Insurance
  • No change is allowed.
Health FSA
  • No change is allowed.
Dependent Care FSA
  • No change in contributions.
  • Coverage ceases. 
Supplemental Life Insurance
  • No change is allowed.

Reviewed 06/2019

Return From Paid Leave In Excess of 30 Consecutive Calendar Days

Health Insurance
  • No change is allowed.
Dental Insurance
  • No change is allowed.
Health FSA
  • No change is allowed.
Dependent Care FSA
  • No change is allowed
Supplemental Life Insurance
  • No change is allowed.

Reviewed 06/2019

Commence Paid Military Leave

Health Insurance
  • No change is allowed.
Dental Insurance
  • No change is allowed.
Health FSA
  • No change is allowed.
Dependent Care FSA
  • No change is allowed
Supplemental Life Insurance
  • Your coverage ceases at the end of the month the military leave begins.

Updated 06/2019

Commence Unpaid Military Leave

Health Insurance
  • Coverage for you and eligible family members ceases at the end of the month for which the last premium is paid. 
  • You may pay for continued coverage through COBRA for up to 24 months, if not eligible for Medicare.
Dental Insurance
  • Coverage for you and eligible family members ceases at the end of the month for which the last premium is paid. 
  • You may pay for continued coverage through COBRA for up to 24 months, if not eligible for Medicare.
Health FSA
  • Contributions cease. You may continue to submit claims but only for expenses incurred while you were an eligible employee. 
  • If you wish to retain coverage, you may prepay with your final check, or may make payments on an after-tax basis.
Dependent Care FSA
  • Contributions cease.  You may continue to submit claims but only for expenses incurred while you were an eligible employee.  
Supplemental Life Insurance
  • Your coverage ceases at the end of the month the military leave begins.

Updated 06/2019

Return from Military Leave

Health Insurance
  • Your health insurance will be reinstated.
  • You may elect a different health plan.
  • You may change your coverage level.
  • You may cancel your coverage.
  • If eligible, you may elect the health insurance opt-out.
Dental Insurance
  • Your dental insurance is reinstated.
  • You may change your coverage level.
     
Health FSA
  • Reinstate prior contribution or make a new election.
Dependent Care FSA
  • Reinstate prior contribution or make a new election.
Supplemental Life Insurance
  • Reinstate prior coverage.
  • You may cancel or decrease the amount of your coverage.

Updated 06/2019

Served with a Judgment, Order, or Decree

Judgment, Decree, or Order (including QMCSO) Relating to Health and/or Dental Coverage for Child including a Child of a Domestic

Health Insurance
  • You may add dependent child  if required under order.
  • You may cancel child dependent if other parent provides coverage under order.
Dental Insurance
  • You may add dependent child  if required under order.
  • You may cancel child dependent if other parent provides coverage under order.
Health FSA
  • You may enroll or increase contribution if you add dependent to coverage. 
  • You may decrease or stop your contributions if the event requires another person to provide health or dental coverage for a dependent.  
  • Changes relating to a child of a domestic partner may only be made if both the domestic partner and the child are tax dependents.
Dependent Care FSA
  • No change is allowed.
Supplemental Life Insurance
  • No change is allowed.

Updated 06/2019

You or Your Spouse’s Retirement

Employee’s Retirement (non-SLIP)

Health Insurance
  • Coverage, as an active employee, for you and eligible family members ceases at the end of the month in which you retire. 
  • Eligible for retiree health coverage. You may change your health plan at the time of retirement.
  • As a retiree, you may change to single coverage anytime throughout the year. 
Dental Insurance
  • Coverage, as an active employee, for you and eligible family members ceases at the end of the month in which you retire. 
  • Eligible for retiree dental coverage.
  • As a retiree, you may change to single coverage anytime during the year. 
Health FSA
  • Contributions cease. You may continue to submit claims but only for expenses incurred while you were an eligible employee.
  • If you wish to retain coverage, you may prepay with your final check, or if eligible, you may make payments on an after-tax basis through COBRA.
Dependent Care FSA
  • Contributions cease. You may continue to submit claims but only for expenses incurred while you were an eligible employee. 
Supplemental Life Insurance
  • Your coverage ceases at the end of the month in which you retire.
  • You may pay for continued coverage under the conversion privilege or portability provisions.

Updated 06/2019

Employee’s Retirement (SLIP)

Health Insurance
  • Coverage, as an active employee, for you and eligible family members ceases at the end of the month. 
  • Eligible for retiree health coverage. You may change your health plan.
  • As a retiree, you may change to single coverage anytime throughout the year. 
Dental Insurance
  • Coverage, as an active employee, for you and eligible family members ceases at the end of the month. 
  • Eligible for retiree dental coverage.
  • As a retiree, you may change to single coverage anytime during the year. 
Health FSA
  • Contributions cease. You may continue to submit claims but only for expenses incurred while you were an eligible employee.
  • If you wish to retain coverage, you may prepay with your final check, or if eligible, you may make payments on an after-tax basis through COBRA.
Dependent Care FSA
  • Contributions cease. You may continue to submit claims but only for expenses incurred while you were an eligible employee. 
Supplemental Life Insurance
  • Your coverage ceases at the end of the month in which you retire. You may pay for continued coverage under the conversion or portability provisions.

Updated 06/2019

Spouse Is a SLIP Participant and Exhausts SLIP Account or SLIP Eligibility Ends

Health Insurance
  • You may enroll your spouse in coverage.
  • You may change your health plan.
Dental Insurance
  • Not applicable
Health FSA
  • Not applicable
Dependent Care FSA
  • Not applicable
Supplemental Life Insurance
  • Not applicable

Updated 06/2019

Spouse Loses Coverage Due or Retirement or Spouse Loses Retiree Coverage

Health Insurance
  • You may enroll your spouse in coverage.
  • You may change your health plan.
Dental Insurance
  • You may enroll your spouse in coverage.
Health FSA
  • Not applicable
Dependent Care FSA
  • Not applicable
Supplemental Life Insurance
  • You may enroll in or increase life coverage if your spouse is no longer employed which resulted in a loss of group life insurance. Satisfactory evidence of insurability is required.
  • You may cancel or decrease your coverage.

Updated 06/2019

You, Your Spouse or Your Dependent Becomes Entitled to Medicare or Medicaid

Employee, Spouse, or Dependent Enrolled in Employer’s Health Plan Becomes Entitled to Medicare or Medicaid

Health Insurance
  • You may cancel coverage for the eligible family member entitled to Medicare or Medicaid.
  • You may cancel your coverage if you become covered by Medicare or Medicaid. If eligible, you may elect the health insurance opt-out.
Dental Insurance
  • You may cancel coverage for you and the eligible family member entitled to Medicaid.
Health FSA
  • You may increase or decrease contribution. 
Dependent Care FSA
  • No change is allowed.
Supplemental Life Insurance
  • No change is allowed.

Updated 06/2019

Employee, Spouse, or Dependent Loses Entitlement to Medicare, Medicaid, hawk-i, Any Group Health Coverage Sponsored by a Governm

Updated Health Insurance
  • You may enroll the eligible family member that lost coverage.
Dental Insurance
  • You may enroll the eligible family member that lost coverage.
Health FSA
  • You may increase your contribution. 
Dependent Care FSA
  • No change is allowed.
Supplemental Life Insurance
  • No change is allowed.

Updated 06/2019 

Change in Cost by Your Dependent Care Provider

Change in Your Childcare Provider Rates

Health Insurance
  • No change is allowed.
Dental Insurance
  • No change is allowed.
Health FSA
  • No change is allowed.
Dependent Care FSA
  • You may increase or decrease contribution that corresponds to new costs.
Supplemental Life Insurance
  • No change is allowed.

Updated 06/2019

Change Childcare Provider, or Number of Hours Worked by Childcare Provider

Health Insurance
  • No change is allowed.
Dental Insurance
  • No change is allowed.
Health FSA
  • No change is allowed.
Dependent Care FSA
  • You may increase or decrease contribution that corresponds to new costs.
Supplemental Life Insurance
  • No change is allowed.

Updated 06/2019

Newly Eligible Dependent Requiring Dependent Care Service

Health Insurance
  • No change is allowed.
Dental Insurance
  • No change is allowed.
Health FSA
  • No change is allowed.
Dependent Care FSA
  • You may increase or decrease contribution that corresponds to new costs.
Supplemental Life Insurance
  • No change is allowed.

Updated 06/2019