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Typically, employees can only make a change to benefit elections during the Annual Open Enrollment period.  However, employees may be permitted to request election changes during the  plan year if the change is requested  account of and is consistent with a qualified life change event.  Most events do not permit employees to change health plans; however,  you may be eligible to add and/or remove dependent coverage and/or  change your Reimbursement Account elections and other benefits (if applicable). 

Qualified Life Event rules are governed by the IRS.  Listed below you will find high level guidelines for what is permitted for a qualified life event.  If you have questions about a specific scenario,  please contact the Benefits Information Line at 951-955-4981 Option 1.

Making Changes to your Benefits

    Birth, Adoption or Legal Guardianship

    Employee may request within 60 days from event to enroll eligible dependents on existing medical, dental, or vision plan elections.
    Employee may request to enroll or increase their current election.
    Employee may elect supplemental Life Insurance for their new dependent if they have current supplemental coverage for themselves.

    Marriage or Domestic Partnership Registration

    Employee may request within 60 days from event to enroll newly eligible dependents on their medical, dental, or vision plan. 
    Employee may also enroll or increase their current FSA election. 
    Employee may elect supplemental Life Insurance for their new dependent if they have current supplemental coverage for themselves.

    Death of a Dependent

    If the dependent was enrolled in Supplemental life coverage, employee will contact the Benefit Division at (951) 955-4981, to file a claim for the death benefit.
    Life insurance benefits for dependent life are payable to the employee. 
    A certified copy of the Certificate of Death, which can be obtained from the County were the dependent passed, or from the funeral service provider, in order to complete the claim. 
    Employee must request remove the dependent from health benefits or may newly elect health benefits within 60 days of loss of coverage. 
    Employee may enroll, increase, or decrease their FSA annual election.

    Dependent Becomes Ineligible

    At age 26, your child will lose eligibility for health benefits as your dependent, regardless of whether he or she is still in school. 
    He or she will be dropped from coverage automatically at the end of the month of their 26th birthday. 
    Continued coverage may be available for permanently disabled dependents; contact a Benefits Specialist to learn more. 
    Employee may decrease FSA Election.

    Divorce or Termination of Domestic Partnership

    Employee must request to cancel health and life insurance coverage for their spouse/domestic partner and newly ineligible children effective the first of the month following the event. 

    If the employee fails to notify the County of divorce or termination of domestic partnership in a timely fashion the cancellation date may be effected resulting in additional premiums being owed. 

    Employee may enroll, increase, or decrease their FSA annual election.

    Name/Address Change

    Making sure your home and mailing addresses are correct in the HR System is critical so that you will continue to receive special mailings that are sent to the mailing address. 

    You can make the change by completing an Address Change in PeopleSoft under the Personal Details tile. If you change your name, be sure to notify Social Security. 

     See the Social Security web site for more information, or visit your local Social Security office. Contact your supervisor or department representative to learn how to submit an updated Social Security card. 

    Employee may elect to enroll self and dependent(s) if change caused employee to gain eligibility for plans previously unavailable.

    New Hire

    Employee may request enrollment within 60 days from date of hire to elect medical, dental, vision, FSA, and life insurance coverage.

    Change in Employment Status/Work Schedule

    Employee may elect to enroll self and dependent(s) if change caused employee to gain eligibility for plans previously unavailable. 

    Employee may elect to enroll and increase or decrease annual FSA election amount.

    Change in Health Coverage for Employee or Spouse

    Employee may opt-out (self) and/or remove dependent(s) if they newly gain group health coverage through a spouse or domestic partner. 

    Employee may enroll self if health group coverage is lost through spouse or domestic partner and may enroll dependent(s). 

    Employee may elect to enroll and increase or decrease annual FSA election amount.

    Frequently Asked Questions

      What are Qualified Change of Status Events?

      Answer: The benefit elections you make as a new hire or during Annual Enrollment will stay in effect for the entire plan year if you remain eligible for benefits. Each year, during the Annual Enrollment period, you have an opportunity to change your coverage elections for the following year. However, after Annual Enrollment ends, you can make changes to your health care and FSA coverage ONLY if they are on account of and consistent with a qualified change of status as defined by the Internal Revenue Service. Qualified status changes include:

      • Marriage or registration of a domestic partner
      • Divorce or separation from a registered domestic partner
      • Birth or adoption of a child
      • Death of a spouse/registered domestic partner or a child
      • Change in your spouse/registered domestic partner’s employment
      • Significant changes in your spouse/registered domestic partner’s employer’s medical coverage
      • Child’s loss of eligibility due to age or marital status
      • Full-time/part-time employment status change that results in an insurance eligibility change
      • You, your spouse, or your dependent child becomes eligible for Medicare or Medicaid
      • A judgment, decree, or court order requires a coverage change
      • Commencement of or return from an unpaid leave of absence most status changes are easy to manage.

       
      Most status changes are easy to manage. Simply complete a Benefit Election Form and return it to your department representative within 60 days after the event that caused the status change. You must include documentation of the event (such as a marriage license).


      Most changes are made prospectively from the date that Human Resources receives a properly completed and signed Benefit Election Form. Exceptions are made for birth or adoption to comply with the special enrollment rights defined under the Health Insurance Portability and
      Accountability Act. 

      What is the Consistency Rule?

      Answer: There is a special “Consistency Rule” that applies to these change-of-status events: Any change to your elections must be on account of and consistent with the event. For example, if your dependent loses eligibility for coverage you may cancel health coverage only for that dependent. Or, if you get married you may add your new spouse and any eligible step-children to currently elected plans, but you may not elect to change health plans.

      How long do I have to make the change?

      Answer: You have 60 days after the day of the event to a make your change. Simply complete a Benefit Election Form and return it to your department representative within 60 days after the event that caused the status change. You must include documentation of the event (such as a marriage license, birth certificate etc.). Most changes are made prospectively from the date that Human Resources receives a properly completed and signed Benefit Election Form. Exceptions are made for birth or adoption to comply with the special enrollment rights defined under the Health Insurance Portability and Accountability Act.

      What kind of supporting documentation do I need?

      Answer: You must provide documentation to support your election change by documenting the change-of-status event that you base your election change. The documentation must show the date of the event. Some examples of appropriate documentation are:

      Change-of-Status Event

      Example of Documentation

      Marriage

      Marriage certificate of Affidavit of Marriage

      Registration of Domestic Partner

      Copy of the Declaration of Domestic Partnership accepted by the Secretary of the State.

      Divorce

      A copy of your finalized divorce decree

      Birth of a child

      Birth Certificate, the hospital certificate may be used temporarily to add the child until the Birth Certificate is obtained.

      Adoption

      Copies of the adoption papers

      Death of a Spouse of Dependent

      Copy of the Death Certificate

      A judgment, decree, or court order

      A copy of the judgment, decree, or court order

       

      Why doesn't the county allow me to make election changes whenever I want?

      Answer: The County’s ability to allow employees to cancel or change health plan elections is governed by the Internal Revenue Code and by health plan carrier contracts. The County’s policies to grant mid-year changes are established to conform to these requirements. Section 125 of the Internal Revenue Code (IRC) governs how employers provide benefits to employees on a pre-tax basis. After an employee has made an initial enrollment election, outside of Annual Enrollment, Section 125 does permit changes except for certain, specific reasons. The permitted Section 125 changes are the qualified “change-of-status” events described above. (This booklet is provided to all eligible employees every year during annual enrollment. Unfortunately, the County is required to follow this Internal Revenue Code Section consistently or ALL County employees could become immediately responsible for paying taxes on benefits. To insure that this does not occur, the County adheres to the requirements of Section 125 for the protection of all employees. The County’s carrier contracts are written to comply with IRC section 125 and they govern when an enrollment change will be accepted and the effective date of the change. Outside of the annual open enrollment period, changes are only accepted for Section 125 permitted mid-year changes.

      When is Open Enrollment?

      Answer: Open Enrollment occurs each fall for coverage beginning January 1st of the following plan year. The exact dates may vary, but generally the period for Active employees is September and October.