TSS - Change in Benefits Election after Change in Life Status (Qualified Status Changes)

Change in Benefits Election after Change in Life Status (Qualified Status Changes)

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First Published  :Sun Nov 30 03:52:53 GMT 2014
Last Modified  :Tue May 15 20:26:35 GMT 2018
Last Published  :Tue May 15 20:26:35 GMT 2018
Summary :  Reference for benefits eligible employees who have inquiries about changes in their benefits elections after a change in status or a recent life event. Audience: Benefits Eligible Employees

Response

Primary Information

    This information pertains to Benefits Eligible Faculty and Staff.
    See also Life and Career Changes on the Access Tufts site!
    For Post Doc changes, please contact Cynthia Linton: (617) 636-2701.

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     You may make a change to your election if you have a qualified change in status (as described below) and the election change is on account of and consistent with the change in status. To change your elections, you must notify the University’s Human Resources Benefits Office within 31 days of the change in status and provide any proof of the change as may be required by the University; otherwise, you will be required to wait until the next annual open enrollment, usually early November of each year (including modifications within the Tufts Tiered Health Plans). 
     
    The following events are considered changes in status for purposes of the Plan:
     
    • Legal marriage 
    • Commencement of a qualified Qualified Domestic Partner relationship 
    • Divorce, legal separation or termination of a Qualified Domestic Partner
    • Birth, adoption, or placement for adoption of your child
    • Death of a Spouse or Qualified Domestic Partner or dependent
    • You, your spouse, Qualified Domestic Partner or eligible dependent reach the age limit for coverage (age 26)
    • A move out of your health plan’s service area (only applies if enrolled in Quality Tiered Plan for domestic (US) employees)
    • You, your Spouse, Qualified Domestic Partner or eligible dependent begins or returns from an unpaid leave of absence
    • You, your Spouse, Qualified Domestic Partner or eligible dependent has a change in job status that affects eligibility for coverage under a Tufts benefit plan or a plan of your eligible dependent’s employer
    • Other events that will permit a change in your health coverage elections include (1) a judgment, decree, or order resulting from a divorce, legal separation, annulment, or change in legal custody (including a qualified medical child support order or “QMCSO”) that requires health coverage for your child or foster child, (2) you, your Spouse, or child becoming entitled to Medicare benefits; or (3) you, your Spouse, or child becoming entitled to a special enrollment right; (4) Open Enrollment elections made by a spouse. (5) A Dependent who is moving to the USA can be added to coverage with proof of passport stamp and plane boarding pass showing the time of arrival. The effective date will be the date the arrival date or the date the documentation is submitted, whichever occurs later.  
    • The only COBRA plan event is the exhaustion of the 18-month period of coverage from a previous employer.  Voluntary termination of a COBRA election prior to the exhaustion of the applicable period of coverage is not a qualified event.  This is true even if there is a severance package or other subsidy from the employer to cover COBRA for a certain period (ex: if the spouse is laid off and the employer is going to pay for COBRA for 3 months then stop, it is not a Qualifying Event to choose to move to Tufts after the 3 months, the decision must be made to decline COBRA at the time of layoff).
     
    All election change requests received more than 31 days after the change in status will not be processed. To change an election after this 31-day period, you will have to wait until the next open enrollment period or another change in status, whichever occurs sooner.

    Rules governing changes to Qualified Benefit Plans are regulated by Section 125 of the IRS Code regarding Cafeteria Plans, which are defined as plans that allow participants to choose between taxable and non-taxable benefits.  Tufts benefits plan is considered a Cafeteria Plan, and must adhere to these regulations.
    Qualified Status Change
     
    Required Documentation Effective Date
    Marriage or the commencement of a QDP relationship
    (qualifies for a change in coverage level and/or health plan)
    Marriage Certificate or Statement of Domestic Partnership
    Proof of Other Coverage if terminating Tufts plan

     
    Date of the event or date this form and documentation is received by TSS, whichever is later.
    Divorce, legal separation, or termination of a QDP RelationshipCourt Document or Statement of Termination of Domestic Partnership
     
    Date this form and documentation is received by TSS unless the legal document stipulates otherwise
    Birth, adoption or placement for adoption of your child
    (qualifies for a change in coverage level and/or health plan)

     
    Birth Certificate for newborn child, statement of birth record letter from the hospital or completed Adoption Paperwork

    Proof of Other Coverage if terminating Tufts plan

     
    Date of the event.
     
    Death of a spouse/QDP or dependent
     
    Death Certificate
     
    Date of the event or date this form and documentation is received by the TSS whichever is later
    A move out of your health plan's service area (in order to select appropriate Tufts Health Plan network)
     
    Change of address form must be completed
     
    Date of the event or date this form and documentation is received by TSS, whichever is later
    You, your spouse/QDP or eligible dependent begins or returns
    from an unpaid leave of absence

     
    Employer documentation is needed.  Documentation would include information on the employer’s letterhead detailing the coverage (Medical, Dental, Vision, etc.), which was gained or lost,   the reason for the change, the affected members, and the date of the change. 
     
    Date of the event or date this form and documentation is received by TSS, whichever is later
    You, your spouse/QDP or eligible dependent has a change in
    job status that effects eligibility for coverage under a Tufts benefit
    plan or a plan of your eligible dependent's employer

     
    Employer documentation is needed.  Documentation would include information on the employer’s letterhead detailing the coverage (Medical, Dental, Vision, etc.), which was gained or lost,   the reason for the change, the affected members, and the date of the change. 
     
    Date of the event or date this form and documentation is received by TSS, whichever is later
    You, your spouse/QDP or eligible dependent has a change in
    status that affects eligibility for coverage under Medicare,
    Medicaid, or Mass Health

     
    Documentation is needed from Social Security or Department of Health
     
    Date of the event or date this form and documentation is received by the HR Benefits Office, whichever is later
    Reaching age of 26If a dependent is turning 26, no documentation needed. HR adjusts employee's coverage level automatically. If dependent has disability, please read this important information.

    Employees can cover dependent children up to age 26 regardless of whether the child is a tax dependent, in school, or lives at home. If the enrolled employee lives in New England and if the child is enrolled but is not local to the New England area (i.e. the child goes to college in another state), services for that child rendered outside of New England would be considered out of network.

    If the dependent is an employee and has a loss of coverage and wants to enroll in the Tufts University benefits, he/she must provide supporting documentation as proof of the loss of coverage.
    None needed for dependent turning 26 and being removed from plan




















    For enrollment onto plan, Date of birth or date all documentation is received by TSS whichever is later.

     
    COBRA benefits exhausted from another employerNotice of COBRA benefit ending due to timeout.Date of the event or date this form and documentation is received by TSS, whichever is later.
    Spouse/Partners coverage discontinuesProof of Open Enrollment period in effectEffective date of Open Enrollment period.
    Your election change must be on account of and consistent with the change in status. Examples of the consistency requirement include:
     
    • If a new health, dental, or vision benefit becomes available through the University (or an existing benefit is eliminated) during the plan year, or if a similar change occurs under a plan of your Spouse or dependent’s employer, you may elect the new coverage (or may elect another option if a coverage has been eliminated), and may make corresponding election changes regarding similar coverage for the balance of the plan year; however this does not apply to the Health Care Flexible Spending Account.
     
    • If your share of the cost of Health, Dental, or Vision coverage, or daycare provider cost under the Dependent Care Flexible Spending Account, significantly (generally which means 25% or more) increases or coverage is significantly curtailed, you may change your current election and elect similar coverage offered by the University for the balance of the plan year. Cost increases imposed by a daycare provider who is your relative are not considered significant and your Dependent Care Flexible Spending Account election cannot be changed for the balance of the plan year on account of such expense.
     
    If permitted under the applicable insurance contracts, you may be allowed to change health insurance providers during the plan year. Normally, such a change may take place only during the open enrollment period prior to each plan year. However, you may be permitted to change providers where there has been a significant (generally 25% or more) change in the cost or coverage level of you or your Spouse’s health coverage during the plan year, as determined by the University.


    Eligibility:
     
    All active, regular employees at the University are eligible, provided that you are one of the following:
     
    • an exempt or non-exempt employee regularly scheduled to work 17.5 hours or more a week, with a minimum 90 days employment period; or
    • a faculty member with at least a half time (as determined by the academic department), two semester appointment or
    • a party to a job share contract (see summary plan description).
       
    Please see the Summary Plan Description for more information on the necessary requirements for changing your benefits elections after a change in life status. Click here for The Qualified Status Change form.

    Please note that an employee is able to change "plans" (as opposed to modifying the number of people) if the QSC is marriage or birth/adoption.  Under the IRS tag-along rule, if the event is adoption/birth, a spouse or QDP can also be added at the same time as the child. 

    Children of QDP or Spouse are not able to be added to a plan unless there are court documents showing legal guardianship.

Related Information

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Keywords

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