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2014 Flexplan Decision Guide
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FAQs

 

 

Qualified Family or Employment Status Change

Based on IRS rules, you can generally make changes during the year only if you have a qualifying change in your family or employment status. This includes:

  • Marriage, legal separation, divorce or annulment for you or an eligible child.
  • Death of your spouse, your eligible child's spouse or your eligible child.
  • Birth, adoption or placement for adoption.
  • Change in work status for you, your spouse, your eligible child or your eligible child's spouse, e.g., full-time to part-time, when the change affects medical or dental eligibility.
  • Loss of eligibility for your child because of marriage, exceeding the plan's age eligibility limit or no longer being disabled and/or dependent on you for financial support.
  • If your spouse, your eligible child or your eligible child's spouse moves to an area where he/she is outside the service area for his/her employer's plan, you may add yourself, your spouse and/or any eligible children previously covered under that plan to the Flexplan.
  • Change in day care providers, the hours for which care is needed, or the cost of day care.
  • Change in other medical or dental coverage as a result of the annual enrollment for the employer of your spouse, eligible child, or your eligible child's spouse occurring at a different time than HSHS.
  • A significant change in the cost of medical or dental coverage under this Plan or a plan available through the employer of your spouse, your eligible child or your eligible child's spouse.
  • A significant change in the medical or dental coverage available through the employer of your spouse, your eligible child or your eligible child's spouse.

Benefit changes must be consistent with the eligible life event. Contact your local People Services department and complete any necessary forms. You must make changes within 30 days of the life event to change your benefit elections.

Special Enrollment Rights

Based on IRS rules, if you waive HSHS medical coverage for yourself or your dependents (including your spouse), you may be able to enroll yourself and your dependents in the HSHS Healthy Plan during the year if:

  • You or your dependents become ineligible for the other plan's coverage. Loss of coverage may occur due to an employer stopping contributions toward your other coverage or your dependents' other coverage.
  • You acquire a new spouse or a new dependent as a result of a marriage, birth, adoption or placement for adoption.

Special Enrollment Opportunity

HSHS provides a special enrollment opportunity if you or your eligible dependents either:

  • Lose Medicaid or Children's Health Insurance Program (CHIP) coverage because you are no longer eligible, or
  • Become eligible for a state's premium assistance program under Medicaid or CHIP.

For these enrollment opportunities, you will have 60 days – instead of 30 – from the date of the Medicaid/CHIP eligibility change to request enrollment in Flexplan benefits.