Qualifying Life Events
What are Qualifying Life Events?
According to Section 125 of the Internal Revenue Service Code, changes may only be made to plans during Open Enrollment or during a Special Enrollment Period. If a subscriber or their eligible family member experiences a qualified family status change during the plan year, then that is a Qualifying Life Event which would open a Special Enrollment Period allowing the subscriber to make changes to their health insurance coverage outside of Open Enrollment.
It is the responsibility of the employee/subscriber to notify the District Insurance Office, complete the online enrollment process AND provide required documentation within 30 calendar days of the qualifying life event.
If the employee/subscriber fails to submit coverage changes within 30 calendar days following the event date, then they will forfeit the right to make changes to the plan until the next Open Enrollment period or within 30 calendar days of a subsequent qualifying event.
Retirees (retired on or before 06/30/18) and COBRA members must notify PayFlex Systems USA, Inc. within 30 calendar days of the qualifying life event.
Life Events
OUSD New Hire
Required Documentation:
OUSD newly hired / separating employees do not need to submit proof of employment
Start Effective:
First of the month following the start / termination date of employment or insurance coverage
Birth / Adoption
Required Documentation:
Copy of official birth certificate
Start Effective:
Date of birth / adoption
Change of Employment
Required Documentation:
Copy of other employer's letter with start / termination date of employment or insurance coverage
Start / Termination Effective:
First of the month following the start / termination date of employment or insurance coverage
Employees whose premiums have been paid through June will be entitled to insurance coverage through September 30th (for medical, dental, vision, and life plans)
Child Reaching Age 26
Required Documentation:
If child is also an employee of the District and wishes to enroll in individual OUSD insurance coverage, a copy of the coverage termination letter under the parent's non-District plan must be provided
If child is covered under an OUSD employee's benefits, the District will automatically terminate the child's coverage; no proof is required
Start / Termination Effective:
First of the month following the date of the birthday
Death
Required Documentation:
Copy of official Death Certificate
Termination Effective:
Date of death
Divorce / Separation / Dissolutions
Required Documentation:
Copy of official court-stamped divorce decree, marriage dissolution, legal separation, or termination/revocation of Domestic Partnership
Termination Effective:
First of the month following the date of divorce / legal separation / dissolution / revocation / termination
Domestic Partnership
Required Documentation:
Copy of official Declaration of Domestic Partnership
Start Effective:
First of the month following the date of official domestic partnership
Guardianship
Required Documentation:
Copy of official court-order
Start / Termination Effective:
First of the month following the date of the court filing date
First of the month following date of ineligibility / court-order end date
Loss / Gain Eligibility
Required Documentation:
Copy of letter stating reason and effective date of loss / gain of insurance eligibility
Start / Termination Effective:
First of the month following the date of the eligibility change
Marriage
Required Documentation:
Married MORE Than 12 Months:
Tax status "Married Filing Separately" OR "Married Filing Jointly":
Copy of 1040 Tax Return from previous tax year
Tax status "Head of Household":
Official Marriage Certificate copy AND Marriage Attestation form
Married LESS Than 12 Months:
Copy of official Marriage Certificate
Start Effective:
First of the month following the date of official marriage
Medicare Entitlement
Required Documentation:
Medicare ID card copy
Start / Termination Effective:
Medicare entitlement date
Special Enrollment Period:
Within 60 days of Medicare entitlement
Medicaid / CHIP Entitlement or Loss of Eligibility
Required Documentation:
Letter with approval / termination date from Medicaid or CHIP
Start / Termination Effective:
If Medicaid / CHIP start / termination effective date is:
Mid-month - the effective date of coverage through OUSD will be the first of the month following that date
The first of the month - the effective date of coverage through OUSD will match that date
Special Enrollment Period:
Within 60 days of Medicaid / CHIP entitlement / ineligibility