Change Your Benefits

During your employment, you may update or change your benefits when you experience a qualifying change in your family or employment, or during the annual open enrollment period.

30 Day Deadline

When you experience a qualified life event, you have 30 days from the date of the event to submit changes to your benefit elections and provide the required supporting documentation. If more than 30 days have elapsed since the date of the qualifying life event, you will not be permitted to make benefit election changes until annual enrollment or you experience another qualifying life event. Benefit changes must be consistent with the life event

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 HSHS Healthy Plan benefits.

 

Qualifying Life Events 

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, dental or vision 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.
• 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.