Qualifying Events
Each year during open enrollment, you elect your benefits coverage for the coming year. Once you have enrolled, you cannot change your health insurance election unless you have a "qualifying event" as listed below:
Change in family status affecting covered persons such as
- Marriage or divorce
- Death of a spouse or dependent child
- Birth or adoption of a child
- Loss of dependent status (e.g., a child reaches the age limit under the plan or is no longer eligible as a dependent)
Change in your employment status affecting your benefits such as
- Beginning or returning from an unpaid leave of absence
- Sabbatical
- Change to/from part-time employment
Change in your spouse's employment status causing a gain or loss of health coverage for you or your dependents
- Beginning or ending employment
- Increasing or decreasing hours
- Strike or lockout
Changes associated with a spouse's open enrollment period including changes in the type and cost of coverage
Gain or loss of eligibility for Medicare/Medicaid for yourself, spouse, or child
WHAT CHANGES ARE ALLOWED?
If you have a "qualifying event," the change you make to your plan must be consistent with and appropriate for your new circumstances (see examples below) and it must be done within 31 days of the event:
| IF | THEN | CHANGE TAKES EFFECT |
| You give birth to/adopt a child | You must add the child within 30 days of the birth/adoption | The day of the birth or adoption |
| Your spouse loses his/her job | You must add your spouse within 30 days | The first of the month coincident with or following the qualifying event |
| Your dependent child attains the limiting age | You must drop coverage as of the end of that month | Coverage ends the last date of the child's birth month |
| You change your marital status | You have 30 days to add/delete dependents, based on the situation | The first day of the month coincident with or following the qualifying event |
| Your spouse's open enrollment occurs | You have 30 days to add/delete dependents, based on the situation | The first day of the month coincident with or following the qualifying event |
REQUIRED VERIFICATION
Please note that any requested changes to benefits (with the exception of birth/adoption of a child) resulting from a qualifying life event will require substantiation. Human Resources will need to review certificates of coverage (a document provided by the employer indicating loss of insurance coverage and the effective date of the loss), a divorce decree, a marriage certificate, a death certificate, etc. prior to allowing changes to be made under the Carleton group plan. Employees will be unable to make their own changes within the benefitsCONNECT online tool; support through the Benefits Coordinator or Manager will be required.
ADDITIONAL INFORMATION
Be sure to read the information concerning COBRA. It explains how you or your covered family members may extend your group coverage beyond the date it would normally end because of loss of eligibility.
This is only a summary; please refer to plan documents for full details.