VCPFA Plan Changes

You may qualify for a mid-year change if you have recently experienced one of the following life events:

• Change in legal marital status, including marriage, registration of domestic partnership, death of spouse, divorce, legal separation, termination of a domestic partnership, and annulment; with the consequence that there is a gain or loss of coverage due to the change in marital status;
• Change in number of tax dependents, including birth, adoption, placement for adoption or death of a dependent; with the consequence that there is a gain or loss of coverage due to the change in tax dependents;
• Change in employment status or work schedule, including the start or termination of employment by you, your spouse, or your dependent child; this could also include a strike or lockout, a commencement of or return from an unpaid leave of absence, and a change in worksite; any other changes in employment status that change eligibility of the employee, spouse or tax dependent under the benefit plan, such as a change from part-time to full-time or full-time to part-time status, a change from salaried to hourly-paid, or hourly-paid to salaried employment, with the consequence that an individual becomes (or ceases to be) eligible under the plan, constitutes a change in employment
  status under this section;Individuals who terminate employment but are rehired within 30 days from the date of separation must
  continue with their prior benefit elections for the remainder of the plan year; individuals who separate
  from service and are rehired more than 30 days from the date of separation may make new prospective
  benefit elections in the same plan year, except that employees with negative Health Care Flexible
  Spending Account balances must elect a Health Care Flexible Spending Account for the same annual
  pledge amount previously elected.
• Change in a child’s dependent status, either newly satisfying the requirements for dependent child status or ceasing to satisfy them. Events that cause an employee’s tax dependent to satisfy or cease to satisfy eligibility requirements for coverage are: attainment of age, or any similar circumstance as provided in the health plan under which the employee receives coverage; the change allowed is restricted to adding or dropping coverage for the dependent affected;
• Change in the place of residence of the employee, spouse or tax dependent that affects the employee’s eligibility for coverage (e.g., moving out of the HMO service area of the employee’s current plan, or change that affects the accessibility of network providers of the employee);
• Change in an individual’s eligibility for Medicaid or Medicare, such as an employee, spouse or tax dependent becoming entitled to or losing coverage under Medicaid or Part A or Part B of Medicare
• A judgment, decree, or court order resulting from a divorce, legal separation, annulment, or change in legal custody that requires accident or health coverage for an employee’s child, or for a foster child, or any other change in status that entitles an employee, spouse or tax dependent to change benefit elections pursuant to COBRA (Consolidated Omnibus Reconciliation Act), HIPAA (Health Insurance Portability and Accountability Act) or any other law;
• An event that is a special enrollment event under HIPAA, including acquisition of a new dependent
  (when an employee, spouse or new tax dependent is entitled to enroll in a health plan under HIPAA’s
  special enrollment rules, the employee may also elect to enroll other pre-existing dependents or spouse),
  or loss of coverage under another health insurance policy or plan if the coverage is terminated because
  of:
  • Voluntary or involuntary termination of employment or reduction in hours of employment, or death, divorce or legal separation;
  • Termination of employer contributions toward the other coverage, OR
  • If the other coverage was COBRA Continuation Coverage, exhaustion of the coverage;
• A significant increase or decrease in premium cost or coverage, the elimination of an existing plan, or the availability of a new group plan (applies to health plans and Dependent Care Flexible Spending Accounts; does not permit a change to a Health Care Flexible Spending Account contribution/election);
• A change of spouse’s or tax dependent’s coverage, such as an election change made by an employee’s spouse or tax dependent under his or her employer’s cafeteria plan; when an employee makes a change that is consistent with the spouse’s or tax dependent’s election change, for example, if spouses have each elected single coverage under their respective employer’s health plans, and subsequently adopt a child, one spouse could elect to drop coverage, if the other spouse changes his/her election to add
  family coverage. An election change that is made to conform to a change made by a spouse or tax dependent under his or her employer’s open enrollment period may also be permitted;
• For Dependent Care Flexible Spending Accounts, a status change that affects the employee’s eligibility for tax-favored treatment for Dependent Care Flexible Spending Accounts, including a
  change independent care provider, a raise for the provider (except in the instance where the provider is related to the employee), a reduction in care-giver hours due to tax dependent’s enrollment in school, or a change in the number of tax dependents, including a dependent’s loss of eligibility under IRC Section 21 (b).