You should always elect benefits during open enrollment to ensure you get the coverage you need. However, once you make your elections through a cafeteria or Section 125 plan, you are unable to change your elections until the plan year ends. But sometimes qualified life events occur, allowing you to change your elections outside of the standard enrollment period.
How Do I Qualify?
While you are generally only allowed to change your benefits elections during the open enrollment period each year, certain life events provide an exception. Those life events allow you to change your benefits elections in the middle of the plan year if certain requirements are met.
Common Qualifying Events
- Change in status (e.g., marital status, number of dependents and employment status)
- Significant cost changes
- Significant curtailment of coverage
- Change in coverage under the employer’s plan
- Addition or significant improvement of benefits package option
- FMLA leaves of absence
- COBRA qualifying events
- HIPAA special enrollment events
- Medicare or Medicaid entitlement
Some qualified life events may depend on a specific plan’s terms.
Qualifying Life Event Changes and Required Documentation
Change in Legal Marital Status |
Required Documentation |
|---|---|
| Marriage | Marriage certificate |
| Divorce/annulment | Divorce decree/court ruling for annulment |
| Legal Separation | Court order verifying legal separation |
| Death of Spouse | Death certificate |
| Divorce/annulment | Divorce decree/court ruling for annulment |
Change in Number of Dependents |
Required Documentation |
|---|---|
| Birth | Birth certificate |
| Death | Death certificate |
| Adoption/placement for adoption | Court order for adoption/placement for adoption |
Gain or Loss Eligibility for Other Group Coverage (HIPAA special enrollment) |
Required Documentation |
|---|---|
| Group health plan | Documentation from plan or issuer regarding change in eligibility (with effective date) |
Change in Employment Status of Employee or Spouse |
Required Documentation |
|---|---|
| Loss of employment | Termination documents or unemployment |
| Start of employment | Employer documentation of employment start date |
| Change in worksite | Employer documentation showing change and impact on eligibility |
| Leave of absence | Employer documentation stating employee has commenced or returned from leave |
Change in Place of Residence |
Required Documentation |
|---|---|
| Change in place of residence of the employee, spouse or dependent that affects HMO eligibility | Documents indicating how change in residence affects employee eligibility |
| Employee, spouse, or dependent becomes covered under Medicare or Medicaid, or loses eligibility for his or her Medicare or Medicaid coverage (including coverage under a state Children’s Health Insurance Program or CHIP) | Government verification that coverage was gained or lost |
Changes in Coverage |
Required Documentation |
|---|---|
| Significant cost increases | N/A |
| Significant curtailment of coverage | N/A |
| Addition or significant improvement of benefits package option | N/A |
| Change in coverage under other employer plan | Documentation from employer showing change in coverage |
| Loss of health coverage sponsored by governmental or educational institution | Government verification of loss of eligibility |
Other |
Required Documentation |
|---|---|
| Change of custody, judgement, court order or decree requiring health coverage | N/A |
| COBRA qualifying event | N/A |
| FMLA leave | N/A |
| Eligibility for premium assistance subsidy through a Medicaid plan or CHIP | Government verification of eligibility for subsidy (with effective date) |
| Exchange enrollment | Employee representation regarding enrollment in a plan under an exchange |
| Reduction in hours of service to less than 30 hours without loss of eligibility | N/A |
Conclusion
Typically, open enrollment is the short period of time when you can enroll in or make changes to your employee benefits selection. Outside of open enrollment, you often cannot make changes to your benefits until the next open enrollment period.
One exception to this rule is if you experience a life-changing qualifying event that would trigger a special enrollment period. Events such as getting married or divorced, having or adopting children, or losing eligibility for other health coverage can trigger special enrollment rights. Be sure to carefully review plan documents during open enrollment to choose the best benefits offerings for you.
Connect with a UNICO Employee Benefits Advisor for more information.
