IRC Section 125 Change in Status Qualifying Events FAQ

How do I make a change to my medical/dental/vision/life plan mid-year and what are the timeframes?

To make a change in your medical, dental or vision plan/life outside of the annual open enrollment, you must complete a Benefits Election Change Form and submit to the Benefits Section no later than 30 days from the event (60 days for newborns/adoptions/placement for adoption/entitlement or loss of Medicaid/CHIP). These forms may be downloaded from the Benefits webpage or obtained from The Benefits Section. Do not delay submitting the completed forms while you gather the supporting documentation. Benefits must receive the completed forms within the specified timeframes. You must then follow-up with the supporting documentation as soon as it becomes available. Changes between health plans are generally not allowed.

What if I submit a late request for a change in status qualifying event?

If the request is received by Benefits beyond the required timeframes, the change will not be processed. If the request is to delete an ineligible dependent, you will be responsible financially for any claims incurred by that ineligible dependent but the premium changes, if applicable, will not be processed. Late requests to add new dependents will not be processed. You will need to make the change during the annual benefits open enrollment or if you exercise an allowable HIPAA Special Enrollment Right.

What is the consistency rule governing change in status requests?

IRC Section 125 requires that any change in status requests processed must be consistent with the qualifying event. For example, if the employee gets a divorce, it would be a qualifying event to delete the ex-spouse but not to add existing dependent children who were not on the employee’s plan.

Another example is the event of a deceased spouse. It would be a qualifying event to delete the deceased spouse and add the existing dependents, if they were enrolled under the spouse’s health plan, within 30 days from the date of death.

What mid-year (outside of the annual open enrollment period) change-in-status qualifying events allow me to add or delete dependents?

The health plans are governed by Internal Revenue Code Section 125 Rules which permits mid-year plan changes (example to add or delete dependents) only if certain qualifying events are experienced by the employee or dependent. Therefore, a participant may not revoke any elections made, outside of the annual benefits open enrollment period, except as illustrated in the following qualifying events or HIPPA Special Enrollment Rights:

  • A change in the participant’s legal status including marriage, divorce, death of the participant’s spouse, domestic partnership status (post-tax, unless a qualified tax dependent as defined by the Internal Revenue Code and the employee completes a Domestic Partner Certification of Dependent Status Form)
  • A change in the number of dependents that the participant has for federal income tax purposes due to events such as birth, adoption, placement for adoption or death
  • A termination or commencement of employment of the participant, spouse, domestic partner (post-tax unless a qualified tax dependent under the Internal Revenue Code) or dependent of the participant
  • A reduction or increase in the hours of employment such as a switch between part-time and full-time, going on an unpaid leave of absence (LOA)/FMLA or returning from an unpaid LOA/FMLA
  • An event that causes the participant’s dependent to satisfy or cease to satisfy the requirements for coverage due to attainment of age
  • A court order or judgment, decree or change in legal custody including a qualified medical child support order
  • Entitlement to/or loss of Medicare eligibility
  • Entitlement to Premium Assistance, or loss/gain of Medicaid/Children’s Health Insurance Program (CHIP) eligibility (60 days allowed to exercise this HIPAA Special Enrollment Right)
  • Differences in the open enrollment periods between the City and another employer affecting the participant’s spouse or dependent
  • Significant increases in plan costs
  • Significant curtailment in plan benefits
  • HIPAA Special Enrollment Rights. If an employee becomes eligible to exercise any HIPAA Special Enrollment Rights, he/she may change election for the balance of the plan year and file a new election which corresponds with the exercise of those rights. For more information on HIPAA Special Enrollment Rights, please click on the Cigna image on the Benefits web page to review the certificates of coverage.

When do changes to add a newborn, adopted child or child placed for adoption become effective?

Payroll changes to add a newborn/child adopted or placed for adoption are processed in accordance to Florida Statute 641.31(9). If the completed forms are received by Employee Benefits within 31 days of birth, the premium is waived for the first 31 days from birth. If the completed forms are received after the first 31 days but within 60 days of the qualifying event, the new premium will be charged retroactively to the date of the qualifying event.

When do requested changes become effective?

Open enrollment changes become effective January 1 of the upcoming year (with the exception of life insurance increases, which are effective subject to approval from Standard). Outside of the open enrollment period, changes generally become effective the first day of the month following 30 days from the date of the event (with the exception of newborns/adoptions or placement for adoption which become effective on the date of birth, adoption or placement for adoption).

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