Qualifying Status Event

IRS rules permit certain changes outside of Open Enrollment for all enrollees regardless if coverage is paid for by automatic deduction from a paycheck, retirement allowance, or with payment coupons.  IRS regulations strictly govern when and how benefits election changes can be made.  Changes to coverage are only permitted during the Open Enrollment period each year. The coverage elected during the plan year Open Enrollment will be in place for the remainder of that plan year.  However, there are some changes in status, known as a Qualifying Status Event, that permit limited changes to be made during the plan year. Examples of Qualifying Status Event changes include:

  • Birth or adoption/placement for adoption of a child;
  • Death of a dependent;
  • Marriage or divorce;
  • Employee or dependent child’s loss of SCHIP/Medicaid/Medical Assistance coverage;
  • Employee or dependent gain access to a SCHIP/Medicaid subsidy based on residence in another state;
  • Loss of other coverage, such as if coverage under a spouse’s employment ends or a child ceases to be eligible;
  • Gaining eligibility for Medicare (for retirees); or
  • Changes in other coverage which has a different plan year.

Employees have 60 days from the date of the Qualifying Status Event to submit an enrollment form and supporting documentation making changes to benefits.  Any changes submitted after 60 days of the qualifying change in status cannot be accepted and the employee will have to wait until the next Open Enrollment period to make the desired change.

NOTE: Documentation supporting a qualifying event must be submitted with the enrollment form.  For example, requesting to cancel benefits due to obtaining other coverage requires a letter from the employer or insurance provider on company letterhead. The letter must identify all benefits (i.e. medical, dental, life insurance, etc.) for which the person is enrolled, the names of dependents covered and the effective date of the new coverage.  If the employee declines to enroll themselves or a dependent because of other coverage, they may be able to enroll in the future if they should lose that other coverage.

Removing Dependents Who Lose Eligibility

It is the employee’s responsibility to submit an enrollment form to remove any dependent as soon as he/she loses eligibility. If an employee fails to remove the ineligible dependent within 60 days from the date of ineligibility, they will be required to pay the full insurance premium including the State subsidy from the date he/she became ineligible until the date removed. They may face disciplinary action, termination of employment, and/or criminal prosecution for continuing to cover dependents who no longer meet the definition of an eligible dependent. In most cases, dependents that lose eligibility are entitled to COBRA/Continuation Coverage for a limited time, which is not subsidized by the State.  Please see the COBRA/Continuation of Coverage section of the current Benefits Guide for more information.

Ex-Spouse

If an employee is obligated to continue coverage for a former spouse by terms of the divorce, that coverage can be provided for a limited time under COBRA and Maryland law. If COBRA is selected, the ex-spouse will have his/her own account and will be responsible for paying premiums directly. COBRA coverage is not subsidized by the State.

Age 26 Dependent Child

Dependent children who turn age 26 are automatically removed. A COBRA notice will be sent directly to the dependent child.