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
- Marriage, legal separation, divorce or annulment for you or an eligible
- Death of your spouse, your eligible child's spouse or your eligible
- 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
- If you are enrolled in the HSHS Healthy Plan and your hours are reduced from 30 or more per week to less than 30 hours per week yet you remain eligible for HSHS Healthy Plan coverage, you can discontinue coverage for yourself and any enrolled dependents provided you intend to enroll yourself and those dependents in another plan that provides minimum essential coverage per the Affordable Care Act.
- If you are enrolled in the HSHS Healthy Plan and you experience a significant change in the cost of this coverage due to a change in your regularly scheduled hours, you may change to a less expensive HSHS Healthy Plan option for yourself and any enrolled dependents.
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
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
- 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
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.