Change in Status Change in Employee s Marital Status Gain Spouse (e.g. marriage) Enroll new spouse and children (HIPAA Special Enrollment Rights allow new and pre-existing s to be enrolled) Drop employee s or s coverage to enroll in spouse s Enroll new spouse and children (HIPAA Special Enrollment Rights allow new and pre-existing s to be enrolled) Drop employee s or s coverage to enroll in spouse s for newly eligible spouse or s if employee or s become eligible under spouse s Enrollment Rights do not apply if not subject to HIPAA Enroll or Increase coverage for newly eligible s due to marriage Drop or decrease coverage if new spouse is not employed or makes a DCRA coverage election under spouse s Lose Spouse (e.g. divorce, legal separation, annulment, death of spouse) for spouse only Enroll employee or s who lose eligibility under spouse s for spouse only for employee or s who lose eligibility under spouse s to reflect loss of spouse s eligibility Enroll or increase coverage if coverage is lost under spouse s if eligibility is lost due to now residing with the ex-spouse Enrollment Rights allow any s to enroll as long as one loses coverage under spouse s 2012 Page 1
Change in Employee s Number of Dependents Gain Dependent (e.g. birth, adoption) Lose Dependent (e.g. death) (and any other s not previously covered per HIPAA Special Enrollment Rights) for employee or only when coverage is elected under the spouse s only for the who loses eligibility (and any other s not previously covered per HIPAA Special Enrollment Rights) only for the who loses eligibility March 2005 Change in Employment Status of Employee, Spouse, or Dependent That Affects Eligibility Commencement of Employment by Employee or Other Change in Employment Status Triggering Eligibility (e.g. PT to FT, hourly to salaried, etc.) If eligibility was gained for this coverage, Employee may change pre-tax Enroll employee and s If eligibility was gained for this coverage, Employee may change pre-tax Enroll employee and s If eligibility was gained for this coverage, Employee may change pre-tax If eligibility was gained for this coverage, Employee may change pre-tax 2012 Page 2
Commencement of Employment by Spouse or Dependent or Other Change in Employment Status Triggering Eligibility Under Spouse s or Dependent s Plan for if employee, spouse, or is added to spouse s or s for if employee, spouse, or is added to spouse s or s If eligibility is gained under spouse s or s If spouse previously did not work if is added to spouse s Termination of Employee s Employment or Other Change in Employment Status Resulting in Loss of Eligibility (e.g., FT to PT, strike, salaried to hourly, etc.) Termination of Spouse s or Dependent s Employment (or other change in employment status resulting in loss of eligibility under their employer s ) for who loses eligibility Change coverage option (e.g. HMO to PPO) or s who lose eligibility under spouse s or s Enrollment Rights allow any s to enroll as long as one loses coverage under spouse or s for who loses eligibility or s who lose eligibility under spouse s or s Enrollment Rights allow any s to enroll as long as one loses coverage under spouse or s If spouse or loses eligibility under their If spouse loses eligibility under their if spouse is no longer working Enrollment Rights do not apply if excepted benefit 2012 Page 3
Dependent Satisfies or Drops to Satisfy Eligibility Requirements Event by Which Dependent Satisfies Eligibility Requirements Under Employer s Plan (e.g. attaining a specified age, becoming a student, etc.) Event by Which Dependent Ceases to Satisfy Eligibility Requirements Under Employer s Plan (e.g. attaining a specified age, ceasing to be a student, getting married, etc.) Change in Place of Residence Move That Triggers Eligibility Move That Causes Loss of Eligibility (e.g. employee or moves outside HMO service area) only for the who loses eligibility if change in residence affects eligibility for coverage option only for the who loses eligibility if no alternate coverage is To take into account ineligibility of expenses of if eligibility is lost if remains a tax under the cafeteria pre-tax To take into account expenses of pre-tax To take into account expenses of DCRA eligibility is not generally by place of residence DCRA eligibility is not generally by place of residence Even when eligibility is not Even when eligibility is not 2012 Page 4
Change in Cost or Coverage Level Cost Changes With Automatic Increase or Decrease in Elective Contributions Cost Changes With Automatic Increase or Decrease in Elective Contributions Plan may automatically increase or decrease employees elective contributions Significant Cost Increase or Decrease Significant Cost Increase Significant Cost Decrease Increase election and elect coverage under another benefit option providing similar coverage if with decreased cost if not previously enrolled Continue current election at lower cost Significant Curtailment of Coverage Significant Curtailment of Coverage Without Loss of Coverage (e.g. increased deductibles, copays or coinsurance, etc.) under providing similar coverage Plan may automatically increase or decrease employees elective contributions Increase election and elect coverage under another benefit option providing similar coverage if with decreased cost if not previously enrolled Continue election at lower cost under Plan may automatically increase or decrease employees elective contributions Except when cost change is imposed by a care provider who is relative of the employee Decrease election Except when cost change is imposed by a care provider who is relative of the employee election whenever there is a change in providers or change in hours of care Add coverage and elect coverage under another benefit option under employer s or spouse s if Decrease election with decreased cost if not previously enrolled and elect coverage with decreased cost under 2012 Page 5
Significant Curtailment of Coverage With Loss of Coverage under providing similar coverage if similar under under employer s or spouse s if election whenever there is a change in providers or change in hours of care Add coverage under under employer s or spouse s if Addition or Significant Improvement of Benefit Package Option Addition or Significant Improvement of Benefit Package Option Elect the newly-added or improved option, whether or not currently enrolled Elect the newly-added or improved option, whether or not currently enrolled Elect the newly-added or improved option whether or not currently enrolled Elect the newly-added or improved option whether or not currently enrolled Change in Coverage Under Other Employer Plan Other Employer Plan Increases Coverage Other Employer Plan Decreases or Drops Coverage Open Enrollment Under Other Employer Plan for s if employee, spouse and s have elected and s if s have revoked corresponding coverage under other employer corresponding changes for s if employee, spouse and s have elected and s if s have revoked corresponding coverage under other employer corresponding changes Drop or decrease coverage for employee, spouse and s if s have elected corresponding coverage under other employer Elect or increase coverage if employee, spouse and s have revoked corresponding changes for s if employee, spouse and s have elected Elect if employee, spouse and s have revoked corresponding changes 2012 Page 6
Required by Other Laws or Court Orders Loss of Coverage Under Group Health Plan of Governmental or Educational Institution Loss of Coverage Under Group Health Plan of Governmental or Educational Institution COBRA Qualifying Events COBRA Qualifying Events Judgment, Decree or Order Order That Requires Coverage for the Child Under Employee s Plan or if loses eligibility under health of governmental or educational institution Increase pre-tax contribution for COBRA coverage under employer s for Note: Dependent must still qualify as a tax of the employee Enroll child or if loses eligibility under health of governmental or educational institution Increase pre-tax contribution for COBRA coverage under employer s for Note: Dependent must still qualify as a tax of the employee Enroll child Increase pre-tax contribution for COBRA coverage under employer s for Order That Requires Spouse, Former Spouse, or Other Individual to Provide Coverage for the Child for the child for the child 2012 Page 7
Medicare or Medicaid Eligibility Employee, Spouse, or Dependent Enrolled in Employer s Plan Becomes Entitled to Medicare or Medicaid Employee, Spouse or Dependent Loses Eligibility for Medicare or Medicaid FMLA Leaves of Absence Employee s Commencement of Unpaid FMLA Leave for the who becomes entitled to Medicare or Medicaid Enroll employee, spouse, or child who loses eligibility for Medicare or Medicaid during Maintain coverage but discontinue pre-tax contribution during (which will be recovered when employee returns from leave) for the who becomes entitled to Medicare or Medicaid if the dental or vision coverage is tied to the employer s medical coverage Enroll employee, spouse, or child who loses eligibility for Medicare or Medicaid if the dental or vision is tied to the employer s medical coverage during Maintain coverage but discontinue pre-tax contribution during (which will be recovered when employee returns from leave) where employer is more comprehensive than Medicare or Medicaid where employer is less comprehensive than Medicare or Medicaid during Maintain coverage but discontinue pre-tax contribution during (which will be recovered when employee returns from leave) during change in during 2012 Page 8
Employee s Return from Unpaid FMLA Leave If coverage continued, reinstate pre-tax contributions that were discontinued to be Note: up missed contributions on a post-tax basis so that reinstated pre-tax contributions aren t If coverage continued, reinstate pre-tax contributions that were discontinued to be Note: up missed contributions on a post-tax basis so that reinstated pre-tax contributions aren t If coverage continued, reinstate pre-tax contributions that were discontinued to be change in 2012 Page 9