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2017 Benefits Enrollment
Making Changes During Examples of Documentation That May Be Required
the Year—Qualified Birth, marriage, or death certiicate
Status Changes Veriication of an eligible dependent’s change in employment status
Generally, after you have made your or coverage
medical, vision, dental, life, and Court orders for adoption, legal guardianship, legal separation, or
reimbursement account elections, divorce
you can make changes only during
the next open enrollment period. The Following are Examples of Qualifying Status Changes
If you have a qualifying status A change in legal marital status
change during the year and make A change in number of dependents (e.g., death, birth)
appropriate event changes within 31 A change in your employment status of you, your spouse’s, or your
days of the event, you may change dependent(s)
certain beneit plan elections before
the next open enrollment period. The termination of your dependent’s status as a dependent under
A change in status is deined as an the terms of the plan
event which results in the gain or A change in residence or worksite by you or your dependent
loss of eligibility by you or your A judicial decree which requires health insurance coverage for a
dependents. participant’s dependent child
You, your spouse’s, or your dependent’s enrollment for health beneit
If you change your coverage within
31 days of the qualiied change in coverage under Medicare
status, your election changes will Loss of coverage of spouse or dependent
generally be effective on the date of When Coverage Ends
the change in status.
Coverage for you and your dependents ends on your last day of active
If you do not change your coverage employment or on the date you no longer meet the plan’s eligibility
within 31 days of the date the requirements. Coverage for your dependents may also end on the date
change in status occurs, you must they no longer meet the deinition of an eligible dependent. Under certain
wait until the next open enrollment circumstances, you may be able to continue some beneit coverages for
period before making any voluntary yourself and/or dependents through COBRA or portability/conversion
changes to your elections. provisions of the plans.
You must provide information and Certificate of Creditable Coverage
documentation which is necessary to
verify your qualiied change in status When medical coverage for you or any of your dependents ends, you will
as required by the company. receive a certiicate of creditable coverage from the former medical plan
as required by the Health Insurance Portability and Accountability Act
of 1996 (HIPAA). This certiicate provides evidence of previous medical
plan coverage.
6
Making Changes During Examples of Documentation That May Be Required
the Year—Qualified Birth, marriage, or death certiicate
Status Changes Veriication of an eligible dependent’s change in employment status
Generally, after you have made your or coverage
medical, vision, dental, life, and Court orders for adoption, legal guardianship, legal separation, or
reimbursement account elections, divorce
you can make changes only during
the next open enrollment period. The Following are Examples of Qualifying Status Changes
If you have a qualifying status A change in legal marital status
change during the year and make A change in number of dependents (e.g., death, birth)
appropriate event changes within 31 A change in your employment status of you, your spouse’s, or your
days of the event, you may change dependent(s)
certain beneit plan elections before
the next open enrollment period. The termination of your dependent’s status as a dependent under
A change in status is deined as an the terms of the plan
event which results in the gain or A change in residence or worksite by you or your dependent
loss of eligibility by you or your A judicial decree which requires health insurance coverage for a
dependents. participant’s dependent child
You, your spouse’s, or your dependent’s enrollment for health beneit
If you change your coverage within
31 days of the qualiied change in coverage under Medicare
status, your election changes will Loss of coverage of spouse or dependent
generally be effective on the date of When Coverage Ends
the change in status.
Coverage for you and your dependents ends on your last day of active
If you do not change your coverage employment or on the date you no longer meet the plan’s eligibility
within 31 days of the date the requirements. Coverage for your dependents may also end on the date
change in status occurs, you must they no longer meet the deinition of an eligible dependent. Under certain
wait until the next open enrollment circumstances, you may be able to continue some beneit coverages for
period before making any voluntary yourself and/or dependents through COBRA or portability/conversion
changes to your elections. provisions of the plans.
You must provide information and Certificate of Creditable Coverage
documentation which is necessary to
verify your qualiied change in status When medical coverage for you or any of your dependents ends, you will
as required by the company. receive a certiicate of creditable coverage from the former medical plan
as required by the Health Insurance Portability and Accountability Act
of 1996 (HIPAA). This certiicate provides evidence of previous medical
plan coverage.
6
