Changes During the Plan Year to Your Health Care Benefit Elections
IMPORTANT: After this open enrollment period is completed, generally you will not be allowed to change your benefit elections or add/delete dependents until next years’ open enrollment, unless you have a Special Enrollment Event or a Change in Status Event during the plan year as outlined below:
- Special Enrollment Event:
If you are declining enrollment for yourself or your dependents (including your spouse) because of other health insurance or group health plan coverage, you may be able to enroll yourself and your dependents in this plan if you or your dependents lose eligibility for that other coverage (or if your employer stops contributing toward your or your dependents’ other coverage). However, you must request enrollment within 45 days after your or your dependents’ other coverage ends (or after the employer stops contributing towards the other coverage).
In addition, if you have a new dependent as a result of marriage, birth, adoption, or placement for adoption, you may be able to enroll yourself and your dependents. However, you must request enrollment within 45 days after the marriage, adoption, or placement for adoption, or in the event of a birth of a child in which case the enrollment application shall be filed within 180 days of the birth of the child or newly adopted newborn child.
You and your dependents may also enroll in this plan if you (or your dependents):
- have coverage through Medicaid or a State Children’s Health Insurance Program (CHIP) and you (or your dependents) lose eligibility for that coverage. However, you must request enrollment within 60 days after the Medicaid or CHIP coverage ends.
- become eligible for a premium assistance program through Medicaid or CHIP. However, you must request enrollment within 60 days after you (or your dependents) are determined to be eligible for such assistance.
To request special enrollment or obtain more information, contact the EUTF Office at (808) 586-7390 or toll-free at 800-295-0089.
- Change in Status Event During the Plan Year:
EUTF follows the Internal Revenue Service (IRS) regulations on if and when benefits can be changed during the plan year (the plan year being the period July 1 through June 30). The following events may allow certain changes in benefits mid-year, if permitted by the IRS:
- Change in legal marital status (e.g. marriage, divorce/legal separation, death).
- Change in number or status of dependents (e.g. birth, adoption, death).
- Change in employee/spouse/dependent’s employment status, work schedule, or residence that affects their eligibility for benefits (For Active Employees only).
- Coverage of a child due to a QMCSO.
- Entitlement or loss of entitlement to Medicare or Medicaid.
- Certain changes in the cost of coverage, composition of coverage or curtailment of coverage of the employee or spouse’s plan (For Active Employees only).
- Changes consistent with Special Enrollment rights and FMLA leaves.
You must notify your Designated Personnel Office by submitting an EC-1/EC-1H/EC-2/EC-2H Enrollment Change form within 45 days of the mid-year change.
Failure to give EUTF a timely notice (as noted above) may:
- cause you, your Spouse and/or Dependent Child(ren) to lose the right to obtain COBRA Continuation Coverage,
- cause the coverage of a Dependent Child to end when it otherwise might continue because of a disability,
- cause claims to not be able to be considered for payment until eligibility issues have been resolved,
- result in your liability to repay the Plan if any benefits are paid to an ineligible person.
For questions contact the EUTF Office at (808) 586-7390 or toll-free at 1-800-295-0089.