Your decision to participate/not participate
in this plan is irrevocable for the entire Flex Plan year. You cannot change your decision during the plan
year unless you experience a Qualifying Event and have an
approved "Change in Status". It is to your advantage to submit
your change as soon as possible after the Qualifying Event
occurs. Retroactive changes/refunds are not allowed.
For example, if you get divorced in January, but do not submit
an enrollment/change form until April, you will not be
refunded the difference in premiums for the months from
January-May even if you did not have coverage for your ex-spouse
during those months.
Premiums which qualify for sheltering under the Cafeteria
Marriage - Your spouse may be added
to your coverage within 30 days of the marriage date, and the
additional premium amount qualifies under the Cafeteria Plan.
Divorce - You must drop
insurance on your spouse within 30 days of the divorce. Legal
separation does not qualify. Children can be dropped for
coverage if custody is awarded to the spouse.
Birth or adoption of child - Newborn
or adopted children must be added within 30 days of the date
of birth or adoption.
Death of a spouse or dependent - A
deceased spouse or child must be deleted from coverage
within 30 days of death.
Termination or commencement of coverage
for employee, spouse or dependent (including strike or
lockout) - may add or drop coverage within 30 days of event.
Change in eligibility of a dependent
- (such as ineligible due to age, marriage, enlisting in the
military) Over age children must be deleted from coverage
within 30 days of ineligibility. Never-married
children through age 25 are eligible for coverage.
Change of spouse's employment status
(full time to part time or vice versa).
Reduction or increase in employment
Significant change in spouse's
eligibility for health benefits (such as the first time
offering insurance benefits).
Judgment or Order - May change
coverage to provide/cancel coverage for your dependents child
pursuant to a judgment, decree or order resulting from a
divorce, legal separation, annulment or change in legal
HIPAA Special Enrollment - If you
decline enrollment for yourself and your dependents because of
other coverage, you may in the future be able to enroll
yourself and your dependents in this plan under special
enrollment, provided you request enrollment within 30 days
after your other coverage ends. In addition, if you have a
new dependent as a result of marriage, birth, adoption or
placement for adoption, you may be able to add any and all
eligible dependents to your coverage.
Medicare or Medicaid (gain or loss of
eligibility) - If employee, spouse or dependent becomes
entitled to or lose eligibility under Medicare or Medicaid,
coverage may add or delete coverage of the affected
Unpaid Leave of Absence or Family and
(FMLA) - If employee takes an unpaid leave under the FMLA,
coverage can be cancelled.
Significant curtailment of coverage
under a health plan - May revoke election if coverage is
significantly curtailed or ceases during the year.
Change in place or residence or
workplace - The change must affect your eligibility for
coverage (example: You cannot drop health coverage merely
because you moved, unless the move made you ineligible for a
particular health benefit).
Significant increase in health plan
Spouse's Annual Enrollment - You may
make coverage changes to correspond with changes made by your
spouse during their annual enrollment. You must provide proof
that changes were made and your changes cannot be effective
prior to the effective date of changes made by your spouse.