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Change of Status Matrix

Acceptable Events and Actions for Mid-Year Changes

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Summary of qualifying events under Section 125 which allow election changes during the Plan Year and the permissible changes allowed for each Plan Class. For more information contact Human Resources.

1. Status Changes

1.1 Change in Employee’s Legal Marital Status

1.1.1 Employee Gains Spouse: Marriage

1.1.2 Lose Spouse: Divorce, Legal Separation, Annulment, Death of Spouse

1.2 Change in Number of Employee’s Dependents

1.2.1 Gain Dependent: Birth, Adoption, Legal Guardianship

1.2.2 Lose Dependent: Death, Placement for Adoption

1.3 Change in Employment Status of Employee, Spouse, or Dependent that Affects Eligibility

1.3.1 Employee Gains Eligibility under Employer's Plan

1.3.2 Employee Maintains Prior Eligibility under Employer's Plan after return from termination or unpaid leave within 30 days.

1.3.3 Employee Rehired or returns from non-FMLA leave without pay after 30 days

1.3.4 Employee Loses Eligibility under Employer's Plan through Change in Employment

1.3.5 Spouse/Dependent Gains Eligibility under their Employer's Plan

1.3.6 Spouse/Dependent Loses Eligibility under their Employer's Plan

1.4 Event Causing Employee’s Dependent to Satisfy or Cease to Satisfy Eligibility Requirement

1.4.1 Dependent Gains Eligibility under Employee's Plan

1.4.2 Dependent Loses Eligibility under Employee's Plan

1.5 Change in Place of Residence of Employee, Spouse, or Dependent

1.5.1 Move by Employee Causes Gain of Eligibility

1.5.2 Move by Employee causes Loss of Eligibility

1.5.3 Employee moves out of HMO Service Area

1.5.4 Spouse's or Dependent's move causes gain of eligibility

1.5.5 Spouse's or Dependent's move causes loss of eligibility

2. Small Cost Changes

2.1 Small Cost Changes

2.1.1 Employer- Initiated Automatic Small Cost Changes: Includes Collective Bargaining

2.1.2 Employer-Submitted Automatic Small Cost Changes for Individuals

2.1.3 Employee-Initiated Small Cost Changes: DCAP Provider or Personal Policy

3. Significant Cost Changes

3.1 Significant Cost Increases

3.1.1a Employer-Submitted Significant Cost Increase

3.1.1b Permitted Response by Employee to Employer-Submitted Significant Cost Increase

3.2 Significant Cost Decreases

3.2.1a Employer-Submitted Significant Cost Decrease

3.2.1b Permitted Response by Employee to Significant Cost Decrease

4. Significant Curtailment of Coverage

4.1 Significant Coverage Curtailment

4.1.1a Employer-Initiated Significant Coverage Curtailment

4.1.1b Permitted Response by Employee to Significant Coverage Curtailment

4.1.1c Permitted Response by Employee to Curtailment Resulting in Loss of Coverage

5. Addition or Improvement of Benefit Package Option

5.1 Change in Benefits Offered under Cafeteria Plan

5.1.1a Employer Adds New Benefit or Option

5.1.1b Permitted Response by Employee to Addition of New Benefit or Option

5.1.2a Employer Drops Existing Benefit or Option

5.1.2b Permitted Response by Employee to Drop of Existing Benefit or Option

5.1.3a Employer Replaces one Benefit or Option with Similar Benefit or Option

5.1.3b Permitted Response by Employee to Replacement of Benefit or Option

5.1.4a Significant Improvement of Benefit or Option

5.1.4b Permitted Response by Employee to Significant Improvement of Benefit or Option

5.15 Employee changes DCAP providers

5.16 DCAP Provider FN changed rates

6. Change in Coverage Under Another Employer Plan

6.1 Change in Coverage of Spouse or Dependent under Another Employer Plan

6.1.1 Another Employer Plan Adds or Increases Coverage

6.1.2 Another Employer Plan Drops or Decreases Coverage

6.1.3 Open Enrollment under Employer Plan of Spouse or dependent’

6.1.4 Employee, Spouse, or Dependent loses coverage under group health plan of a governmental or educational institution

7. FMLA Leave

7.1 Commencement of FMLA Leave

7.1.1 Employee begins FMLA Leave

7.2 Return from FMLA Leave

7.2.1 Employee returns from FMLA Leave

8. Cobra Events

8.1 COBRA (or similar state law continuation) Events

8.1.1 Employee COBRA Event with Employee remaining eligible for Cafeteria Plan

8.1.2 Spouse/Dependent COBRA Event.

9. Judgment, Decree, or Order

9.1 Judgment, Decree, or Order Requires Coverage of Code § 152 Dependent Child to be Provided by Employee

9.1.1 Judgment, Decree, or Order Requires Coverage under Employee's Plan

9.2 Judgment, Decree, or Order Requires Coverage of Code § 152 Dependent to be Provided by Spouse, Former Spouse, or Other Person

9.2.1 Judgment, Decree, or Order Requires Spouse, Former Spouse, or Other Person to Provide Coverage

10. Entitlement to Medicare or Medicaid

10.1 Employee or Employee’s Spouse or Dependent Becomes Entitled to Medicare and Medicaid

10.1.1 Employee Becomes Entitled

10.1.2 Spouse/Dependent under Employer's Plan Becomes Entitled

10.2 Employee or Employee’s Sp/dep Loses Eligibility for Medicare and Medicaid

10.2.1 Employee Loses Eligibility

10.2.2 Spouse/Dependent under Employer's Plan Loses Eligibility

11. Administrative Events

11.1 Correcting Obvious Errors

11.1.1 Employee mistake in an making election

11.1.2 Employer mistake in recording election

11.2 Employee Fails Medical Underwriting

11.2.1 Participant fails medical underwriting

11.3 Adjustments to Meet Federal Requirements

11.3.1 Changes needed to maintain plan's status under Code § 125 or to prevent violation of the nondiscrimination rules.