Benefits FAQ

What is a qualifying event?[edit]

A qualifying event is a change in family status, such as the birth of a child, loss of a dependent, marriage, or divorce. A qualifying event can also occur in cases where your spouse's employment is terminated. Therefore, it is very important that you make careful and informed decisions regarding your benefits coverage.

How do I add a spouse or dependent to my insurance?[edit]

To add a child, you must complete a new Benefit Application and a dependent child affidavit adding your child and you MUST supply documentation from the hospital stating the birth (your name must appear) for TEMPORARY DOCUMENTATION of your child’s eligibility. Some examples would be a letter from the hospital (preferred), discharge papers, or hospital bracelet (if your name is on the bracelet). You must order the official BIRTH CERTIFICATE and bring it to Jodie Gray when received. Failure to do this will cause your newborn to be dropped from your health benefits! You must also submit a dependent child tax affidavit along with your application.

To add a spouse, you must complete an application and an Affidavit of Spousal Eligibility You must also provide a marriage certificate which has been signed by the clerk of the court within 60 days of marriage. If you are married in another country, you must provide the marriage license and a translated/notarized copy.

When can I make changes to my health insurance plan? How does Open Enrollment work?[edit]

The only time you can make changes to your health insurance, unless there is a qualifying event such as a marriage or birth, is during the State's Open Enrollment period. This is when you may add or delete health plans for the new plan year.*Open Enrollment dates may vary, but is usually sometime in the month of April or May with all changes effective July 1st*.

All changes are made by the Interactive Voice Response (IVR) System. The IVR is an automated telephone enrollment system. You will use a touch tone telephone to enroll, make changes to your plan selections or coverage levels, and add or delete dependents.

As a rule if you don't make any changes, your coverages will roll forward into the next plan year. The exception to this is if you have the Dependent or Health spending accounts; these MUST be renewed every year. However, as contracts with the State end you may be required to enroll or re-enroll in part or all of your health coverage in order for it to be continued. You will be informed when such changes besides the spending accounts are mandatory.

My child is turning 19 and is not enrolled in school, can I continue them on my health benefits policy? What are my options?[edit]

The child may continue as a covered dependent through the end of the month in which the child turns age 25. If your child is no longer eligible for coverage under the State plan, your child can be covered under COBRA benefits for up to 36 months. Please see the Continuation of Coverage section on this web site or contact Jodie Gray.

If I become legally separated or divorced, or my spouse dies, how do I remove my spouse from my coverage?[edit]

A spouse may be removed from your coverage if you are legally separated, divorced or widowed. For separations, you must provide the court order for this separation. Once removed, however, your spouse cannot be re-enrolled until the next open enrollment period. For divorces, you must provide divorce decree. For death, you must provide death certificate. Please contact Jodie Gray to file an enrollment form within 60 days of the date of change to remove your spouse from your coverage.

What if I make a mistake in my coverage or change my mind?[edit]

Under Internal Revenue Service rules, we cannot correct mistakes made by the employees at the time of enrollment. However if it is still within the 60 day period of your initial enrollment, the State may consider allowing the change. Once this period ends changes cannot be made unless there is a qualifying change in family status, or during Open Enrollment. Please be very careful when selecting your coverage.

My spouse's open enrollment period is different from the States Is this a qualifying event?[edit]

The benefits available through your spouse's employer must change in a significant manner as a result of their Open Enrollment in order to be considered a qualifying event. You must provide documentation from your spouse's employer of the benefits available prior to the Open Enrollment and the benefits available after the Open Enrollment for consideration of a significant change.

If I take a Leave of Absence, can I continue my benefits?[edit]

Yes, under certain circumstances, you may be eligible for continuation of coverage. Please see the Continuation of Coverage on the Benefits Office website or contact Jodie Gray.

If I leave State service or one of my dependents becomes ineligible to continue on my benefits, what benefits are available?[edit]

For a review of benefits that are available when you terminate your State employment, or one of your dependents becomes ineligible, please see the Continuation of Coverage section or contact Jodie Gray.