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    Adding and Dropping Insurance Coverage:
    What is a Qualifying Event?

    Generally, your pre‐tax employee benefits elections cannot be changed outside of the normal open enrollment periods. Some exceptions are permitted, but only if the request to change your election is due to an approved “Qualifying Event.” To make an election change following a Qualifying Event, you must submit an Enrollment and Change Form within 30 days of the event. (Exception: Following a birth or an adoption, you have 60 days to request a change in coverage.) Note: Additional documentation is usually required.

    Here is a list of the most common allowable Qualifying Events:
    • Gaining a new eligible dependent (e.g., via birth, adoption or placement for adoption)
    • Marriage or formation of a domestic partnership*
    • Divorce, legal separation or annulment of marriage, dissolution of a domestic partnership
    • Death of spouse/DP or other eligible dependent
    • Change in the employee's or dependent's employment status that affects eligibility under their own group plan
    • A change in the insurance premium cost (30% or greater change in cost to the employee)
    • Spouse's employer makes significant changes in coverage or premium costs (30% or greater change in cost to the employee)
    • Spouse or other eligible dependent gains access to group insurance
    • Dependent no longer meets eligibility criteria or becomes ineligible for other group coverage
    • A court order results in the employee gaining or losing custody of a dependent
    • In conjunction with your spouse's annual election (open enrollment) period
    • Court decree that establishes an employee's financial responsibility for a child's health care
    • A change in public aid recipient (e.g., Medicaid or CHIP) status or Medicare status
    • Change in a managed care plan (HMO) due to primary care provider leaving the network
    *To the extent possible, SPS treats marriage and domestic partnership the same way, but domestic partnerships are not recognized by the IRS and tax consequences differ.

    What is NOT a Qualifying Event?
    Some events are not considered Qualifying Events, and employees generally cannot make plan election changes if these things happen. Some examples of events that are not Qualifying Events include:
    • An employee deciding that they cannot afford coverage for a dependent
    • A spouse’s job loss that does not result in any loss of health coverage
    • A change in insurance carriers
    • Anticipating a divorce. Note: The entry of the divorce decree is a qualifying event, but if a legal separation precedes the divorce and results in a loss of coverage, then the legal separation will become the qualifying event.
    • Employee's resignation from a union or bargaining group
    Who Should I Contact with Additional Questions?
    This is just a summary of information regarding qualifying events. You can also visit the Benefits
    Website at (password: “sps”), or call the Benefits Helpline at (206) 957‐7066.