Making Changes
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When can I change my benefit plans? |
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In general, employees enrolled for benefits under the BeneFlex and BasicCare programs have an opportunity during the annual Open Enrollment period to review their benefit selections and make changes for the upcoming calendar year. Open Enrollment is usually held in late October/early November, and any requested changes are effective the following January 1. Because changes during the year are only permitted if you experience a qualifying change in family status, you should always review your options during Open Enrollment to determine what plans will best meet your needs in the upcoming new year.
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| Q. |
When can I make a change during the year? |
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If you experience a qualifying change in family status, you are allowed to make certain benefit changes. Qualifying status changes include: marriage, legal separation or divorce, gain or loss of a same-gender domestic partner, birth, adoption or legal guardianship of a child, or death of a dependent. Other qualifying events are changes in your or your dependents’ health care coverage due to your spouse or partner‘s employment status, or changes in status for dependent children over age 19 (reaching the maximum age or student status eligibility requirements).
If you do experience a qualifying change in family status, you must contact the Benefit Services Department within 31 days of the event(s) in order to make any allowable changes to your benefits. Refer to the "Qualifying Events" chart provided in your Benefits Enrollment Guide which outlines all qualifying event scenarios and the type of changes allowed for each event.
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| Q. |
I don't want to make any changes this year. Do I have to notify you? |
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If you are currently enrolled for benefits and remain eligible, you are not required to do anything. Your current benefits will "carry over" into the next year, with some exceptions:
- First, the Dependent Care Reimbursement Account (DCRA) and the Health Care Reimbursement Account (HCRA) each requires you to make an active enrollment each year in order to participate, in accordance with IRS rules. Even if you currently participate in the DCRA and/or HCRA plan(s), your election(s) will terminate after December 31st of this year. You must enroll during the Open Enrollment Period if you want to participate in the account(s) next year.
- Second, you are required to notify Benefits Services if you have any dependent(s) currently covered under the health insurance plans but will not meet the definition of eligible dependents as of January 1st. Where necessary, you may be required to provide documentation. Removal of ineligible dependent(s) may mean a change in your level of coverage (for example, from family to employee plus one dependent).
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| Q. |
If I change my medical plan, when will I be notified and what proof will I have to show when I go to the doctor? |
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If you make a change to your medical plan coverage during Open Enrollment, your newly selected plan will be effective January 1st of the following year. Shortly after you've made your benefit selections for next year, a Confirmation Statement of your elections will be mailed to your home. You should review the Confirmation Statement for accuray.
An identification card for the plan you selected will be sent from the Insurance Company and you should present this card when you go to the doctor or the hospital.
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| Q. |
I want to change my medical plan for next year, but I have diabetes. Will the new plan cover me for my diabetes expenses even though I had the condition before I joined the plan? |
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Yes. The new plan that you elect for coverage will cover all eligible expenses under the plan, even for pre-existing conditions, provided that services were received while you are covered. All of the medical plans offered under our benefit programs have a waiver of pre-existing conditions clause. So, if you elect a different medical plan during Open Enrollment, any eligible expenses that you incur on or after January 1st will be considered under the new plan.
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Dependent Changes
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| Q. |
My daughter (who is dependent on me) is graduating from college in May. Can I keep her on my benefit plans until she has her own coverage? |
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| A. |
One of the criteria to determine dependent eligibility for children over age 19 in the current year is full-time student status. If your daughter will no longer be a full-time student, she cannot continue to be covered under the health insurance plans. However, you can elect to continue coverage for her under the federal regulation COBRA; you could continue coverage as long as you pay the premiums (at 100% of the group rate, plus a 2% administration fee).
Coverage under COBRA can be continued on a monthly basis for up to 18 months (although certain circumstances may allow you extend coverage for up to an additional 18 months). You must notify Benefits Services of the qualifying change in status for your dependent, and you may need to change your level of coverage.
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| Q. |
I’m getting married in March. Can I add my fiancé to my benefits now? |
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Your fiancé is not yet an eligible dependent. After your marriage in March, you can add your spouse to the benefit plans in which you are enrolled (because marriage is a considered a Qualifying Event under group plan rules). Contact the Benefit Serviecs Department within 31 days of your date of marriage to make allowable changes to your benefits. You will be required to submit the required forms (including a copy of your marriage certificate) to Benefit Services. Coverage for your spouse will be effective on April 1st (the first of the month following the date of marriage).
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| Q. |
I already have family coverage, but I’m expecting a newborn soon. Do I need to notify you? |
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Yes. Even though a new dependent will not change your level of coverage, we report to the insurance company the name, date of birth, and social security number for each eligible dependent that you elect to cover under your plans. Without that information, claims for the baby will not be processed. When your baby is born, you will need to provide us with information on your dependent so that we can arrange for coverage. To ensure proper coverage and payment of claims, be sure to contact the Benefit Services Department for instructions on enrolling your baby for coverage under your plans.
You will be required to submit required documentation (including a copy of the baby's birth certificate) to Benefit Services within 31 days of the baby's birth in order to complete the enrollment process.
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| Q. |
I’m not married, but I want to cover my partner, who lives with me. Benefits Services says not all domestic partners are eligible for coverage. Why? |
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Our Health Insurance plans allow coverage for a same-gender domestic partner of an eligible employee. If you have an opposite-gender partner, your partner does not qualify as an eligible dependent under our Plans. You would have to marry your opposite gender partner, and as your spouse, s/he would become an eligible dependent under our plans.
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Choosing Coverage
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I need medical coverage for myself and my children. Can I elect the enhanced prescription plan just for myself? |
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No. If you are electing family medical coverage (for yourself plus more than one eligible dependent), you will automatically receive family coverage under the basic prescription plan. Since your level of coverage under the prescription plan must be the same as your level of coverage level under the medical plan, you would have to elect the family level under the enhanced prescription coverage.
Although your medical and prescription plans must be the same coverage level, you may elect different coverage levels for the other benefit plans. For example, if you are eligible for dental benefits, you can choose individual coverage (for yourself only) or for yourself plus one eligible dependent even if you have family medical and prescription coverage.
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I don’t need dental coverage, but my son does — he is having orthodontia treatment. Can I just cover him under the dental plan instead of paying for coverage for myself and for him? |
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No. Eligible dependent(s) can be included in any plan that you are eligible for and elect coverage under, but you cannot enroll an eligible dependent in a plan without also covering yourself.
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| Q. |
Last year, I took life insurance for 1.5 times my base salary. Can I increase my coverage for next year? |
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Yes, you may increase your life insurance coverage amount during Open Enrollment. However, if you request coverage that is more than one level (.5) higher then your current amount, you will be required to show evidence of good health satisfactory to the insurance company (Aetna) before the new coverage level takes effect. Therefore, a request to change from 1x to 1.5x your base salary would be approved, but if you want to elect coverage for 2x, 3x or 4x your base salary, you will be asked to complete an "Evidence of Insurability" form that will be reviewed by the insurance company. Depending on the information provided, Aetna may require additional information regarding your health and/or a physical exam (possibly at your own expense) before they can make a recommendation as to whether your requested coverage is approved.
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| Q. |
If I waive long term disability coverage, can I enroll for coverage in the future? |
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Yes – every year during Open Enrollment, eligible employees* can reconsider their choices for the upcoming year. Employees who are eligible for long term disability coverage are allowed to elect the base level of coverage (40% of monthly earnings, up to $4,000 per month) without having to provide further documentation.
Eligible employees* who wish to elect a higher option will be required to complete an "Evidence of Insurability" form to prove good health satisfactory to the insurance company before coverage is approved. Depending on the information provided, the insurer (UNUMProvident) may require additional information regarding your health and/or a physical exam (possibly at your own expense) before they can approve your coverage as requested. You will also have to go through this process if you have coverage but want to elect a higher level of long term disability coverage during a subsequent Open Enrollment period.
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| * Not all employees are eligible for long term disability coverage. To find out if you are eligible for this benefit, please consult your Benefits Enrollment Guide. |
