During Open Enrollment you can add and delete coverage for yourself or any of your eligible dependents. Open Enrollment is held each fall with changes taking effect the following January. Other than Open Enrollment, employees can only make mid-year changes for the reasons listed below.
Qualifying Events for Mid-Year Changes
In general, mid-year changes are allowed only when certain events happen to you. These are a selection of events (called “Qualifying Events”) that affect who can and should be enrolled in health benefits. These events all take place on specific dates (for example, a date of marriage, birth, death, divorce, loss of other coverage, and so on). You must apply to make the change no later than 31 days after the event. You must enclose documentation of the event (such as proof of marriage), and the documentation must show the date of the event.
Events that allow you to add coverage mid-year
- Your date of hire with Marymount University.
- Your regularly scheduled hours are increased from part-time to full-time hours (30 or more hours per week).
- You return to work after having been on an approved leave of absence and, during the leave of absence, you elected not to continue your health benefits.
- Birth of a child and adoption (Note that you can also enroll yourself at this time, not just your new child).
- A child becomes eligible by reason of issuance of a Qualified Medical Child Support Order.
- Your unmarried child who is between the ages of 19 and 23 enrolls in college full-time.
- You get married (you can enroll yourself as well as your spouse).
- Any other change in you or your dependent’s employment status that results from a loss or gain of eligibility.
- You move, and your new place of residence does not allow you to be covered under the medical plan you are enrolled in. (Technically, you can’t add coverage at this time, but you can switch from one medical plan to another.)
- You lose coverage through another group medical plan for one of the following reasons:
- Exhaustion of COBRA continuation coverage
- Loss of eligibility for coverage under the other plan, because of termination of employment, change of employment status, divorce or death of the person through whom the other coverage was provided.
- Cessation of the other employer’s contributions toward the cost of the other coverage, or termination of the other employer’s group medical plan.
Events that allow you to drop coverage (or delete coverage for a dependent) mid-year
You cannot request retroactive termination of your coverage for either you and/or your dependent.
The change in coverage will take place on the date of the event. The deadline to apply for a change in coverage is 31 days after the date of the event. As with all other mid-year changes, you must provide a copy of documentation of the event (for example, the Court order dissolving your marriage), and the documentation must show the date of the event.
- Marriage, death of spouse, divorce, legal separation, or annulment.
- Birth, death, or adoption.
- Change in your or your dependent’s employment status, including termination or commencement of employment.
- Any change in your or your dependent’s employment status that results from a loss or gain of eligibility.
- An individual becomes eligible for coverage under Medicare or Medicaid.
- Change in your dependent’s eligibility for coverage due to age, student status, marriage, or similar circumstances.
- You move, and your new place of residence does not allow you to be covered under the medical plan you are enrolled in.
- If your spouse’s or dependent’s Open Enrollment period occurs at a different time of year, and your spouse or dependent changes his or her elections, you may make a mid-year election change that corresponds with their change.
- Your Health Plan costs change significantly during the year.
There is a “Consistency Rule” that applies to these changes. Any change to your payroll deductions must correspond with the life status event. (For example, if your dependent loses eligibility for coverage you may cancel health coverage only for that dependent.)