December> Important Reminder
Changing Your Group Insurance Benefits Mid-Year
Life is full of surprises, and sometimes these surprises are changes in family circumstances resulting in a need to adjust benefits elections. Because contributions for most benefits are deducted on a pre-tax basis, the IRS has regulations that specify when, outside of annual enrollment or the new hire period, changes to elections can be made. If you have what is called a “qualified change of status”, also known as a “life event” or “qualifying event”, you can make certain corresponding adjustments to your benefits.
Common examples of “qualified change of status” events include:
- Marriage, divorce, annulment, legal separation, or spouse’s death
- Birth, adoption, entry or expiration of a medical child support order, or dependent’s death
- Significant change in residence if the change affects you or your dependents’ current plan eligibility
- Starting or ending employment, starting or returning from unpaid leave of absence, or a change of job status (e.g., from part-time to full-time)
- Change in dependent’s eligibility
- Change in coverage or cost of other benefit plans available to you and your family
- Change in Medicare, Medicaid or Children’s Health Insurance Program (CHIP) enrollment status
When you, as an eligible participant in UT Benefits, experience one of these qualified events, you generally have 31 days from the date of the qualifying change of status event to notify your institution’s Benefits Office and make applicable corresponding benefit changes. If the qualifying event is a change in CHIP status, you have 60 days to report the event. Any change in benefits must correspond with the type of event. For example, for the birth of a child, you can add or increase medical coverage but not drop or decrease.
If you don’t elect the corresponding change within the 31 day period (60 day for CHIP status changes), you lose the ability to make that change mid-year. Instead, you will be required to wait until the next annual enrollment period, and the changes will take effect the beginning of the next plan year on September 1. Evidence of Insurability may be required to add certain benefit coverages if you wait until annual enrollment instead of enrolling during the qualified status change period.
Any event causing loss of eligibility for coverage such as a divorce, must be reported as soon as possible so coverage can be terminated for that individual and the individual can be notified of his or her right to any continuation coverage available under COBRA.
An ineligible individual who receives benefits to which they were not legally entitled can be required to repay those benefits. Neglecting to report a status change that results in ineligibility for coverage is also a violation of UT System policy and may result in disciplinary action. In some cases, a failure to report or remove an ineligible individual from coverage may also constitute insurance fraud which may be reported to the Texas Department of Insurance for investigation and possible legal action.
For questions regarding changes of status, please refer to contact your Institution Benefits Office.