Thursday, March 11, 2010
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Home » Mid-Year Election Changes
Annual Enrollment is over, what now?

Annual Enrollment provides a golden opportunity each year in the fall.  You can add and delete coverage for yourself, and for any eligible dependents, without worry about restrictions.  Now that Annual Enrollment is over, what changes can you make mid-year without waiting for the next Annual Enrollment period? 

Once you have made your benefit choices as a new hire or during Annual Enrollment, they are fixed for the entire plan year.  You can make election changes ONLY when they are on account of and consistent with a "Qualified" change-of-status as defined by the Internal Revenue Service (IRS) code.

The vast majority of change-status-events are simple and easy to manage.  To make consistent election changes in case of birth, marriage, death, divorce, etc., simply complete a Benefit Election Form and return it to your department representative within 60 days after the date of the event, and enclose documentation of the event (such as proof of marriage).  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.

Click here to learn more about mid-year election changes
  

Mid-Year Election Change FAQ's
What are "Qualified" change-of-status events?
  • Marriage or registration of a domestic partner
  • Divorce or separation from a domestic partner
  • Birth or adoption of a child
  • Death of a spouse/domestic partner or dependent
  • Change in your spouse/domestic partner's employer's medical coverage
  • Child's loss of eligibility due to age or marital status
  • Commencement of or return from an unpaid leave of absence
  • A residence change effecting eligibility for you, your spouse or a dependent
  • You, your spouse or dependent becomes eligible for Medicare or Medicaid
  • A judgment, decree or court order that requires a coverage change
What is the “Consistency Rule”?

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?

You must submit your completed Benefit Election Form and supporting documentation to your department representative within 60 days after the date of the event. 

What kind of supporting documentation do I need?

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

 When will my mid-year election changes be effective?

Most changes are made prospectively, the first of the month following, from the date that Human Resources receives your Benefit Election Form. Exceptions are made for Birth and Adoption to comply with the special enrollment rights defined under the Health Insurance Portability and Accountability Act.

Where can I get a Benefit Election Form?

Benefit Election Forms are available from your department representative, on this website, or by contacting the Benefits Information Line at (951) 955-4981.

Why doesn’t the County allow me to make election changes whenever I want to?

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. 
  

 
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