Can I Change My Benefits Coverage?

When families have changes in their lives, it’s important to consider how these changes may impact your employer-sponsored benefits. Can I change my benefits coverage? Yes, some of these life-changes may allow you to add benefits and some life-changes may allow you to cancel benefits.

Qualifying Event

Here are a few things to keep in mind as your family goes through changes, known in the benefits world as “Qualifying Events.”

• What kinds of things constitute a Qualifying Event where I could add coverage for myself or dependents?
  • Marriage
  • Divorce
  • Birth/Adoption
  • Loss of Other Group Coverage
  • Loss of Medicaid or CHIP

• What kinds of things constitute a Qualifying Event where I could cancel coverage for myself or dependents?
  • Marriage
  • Divorce
  • Death of Spouse or Dependent
  • Legal Separation
  • Change in Eligibility Status of a Dependent
  • The gain of Other Group Coverage
  • Eligibility/Enrollment with Medicare/Medicaid or CHIP

• Is there a certain amount of time that I must make benefit changes after my Qualifying Event? Yes! But it varies depending on the Qualifying Event you have experienced.
  • For gain or loss of eligibility for Medicaid or CHIP, you have 60 days from the event date to submit your change request.
  • For all other Qualifying Events, you have 30 days from the event date to submit your change request.

How to Make a Change

• What needs to be submitted for a benefit change?
  • Qualifying Event form – this form outlines the reason for the benefits change request.
  • Benefit change form(s) – requesting the new coverage, cancellation of coverage, or addition/deletion of a dependent/spouse.
  • Proof of the Qualifying Event – such proof may be a marriage certificate, divorce decree, birth certificate, or proof of group coverage loss or gain, for example.

• Are there any pitfalls I should look out for with these change requests?
  • In a birth situation, don’t wait for the newborn’s Social Security number before you make the coverage addition request. The insurance carriers won’t need it to get the baby added.
  • Complete your Qualifying Event form and send it in, even if you don’t have the “proof” of the event yet. It’s more important to have the change request on file timely. Proof can be provided later if requested.
  • Pay careful attention to the timing of your request. Carriers don’t have to extend coverage beyond those timelines and your next opportunity to make a coverage change will be during your plan’s next Open Enrollment period.
  • The longer you wait to submit your coverage change request, the more potential back-premium you will owe for your coverage change. Submitting as soon as possible is the best way to go!

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