Health Insurance - Changing Your Coverage

If your health benefit premium contributions are being deducted from your pay on a pretax basis, then you may only change your coverage level, coverage option (e.g., PPO to HMO) and pretax deduction during open enrollment, unless you have a special enrollment right or other qualifying event.

If your health insurance deductions are being taken on an after tax basis, you may change your coverage level anytime during the year, but coverage of new individuals is subject to a five pay-period wait unless you have a qualifying event. Refer to Changing Your Coverage in the Health Care section of the Benefits Handbook.

If you add dependents without a qualifying event, the employee portion of the premium will remain pretax and the dependent portion will be an after tax deduction until the next plan year.

To make changes, you must complete and submit a new RF Benefits Enrollment Form to your campus benefits office within 60 days of the event. (If you have HMO coverage other than Independent Health Association (IHA), you must complete an additional enrollment form.) If the newly completed enrollment form is received by your campus benefits office within 60 days of the event, the change is effective retroactively to the date of the event. 

Qualifying Events

A qualifying event is a change in an employee's or dependent's status that permits a change to be made in the pretax health insurance elections outside of the annual enrollment period.  The change in status must result in a gain or loss of coverage or coverage options.  The change in health insurance election must be consistent with the change in status. For details refer to the Health Care section of the Benefits Handbook or Postdoctoral Benefits Handbook. These rules are governed by the federal tax code. 

Special Enrollment Rights

Apart from qualifying events, special enrollment rights allow you to make changes to your medical (PPO plan/HMO) coverage (but not Dental Care, Vision Care, or Health Care Flexible Spending Accounts), outside of your initial enrollment period or the annual open enrollment period in three specific circumstances: (1.) you gain a dependent, (2.) you or a dependent loses coverage under another plan, and (3.) you or a dependent becomes eligible for assistance through a State Children's Health Insurance Plan.  These specific circumstances are based on rules enacted by the Health Insurance Portability and Accountability Act (HIPAA).

For additional information on special enrollment rules, refer to the Benefits Handbook or Postdoctoral Benefits Handbook.