Qualified Change in Status

After you enroll for coverage, the level and type of coverage you selected (for example, single or family medical coverage, or the amount you elected to contribute to a flexible spending account, etc.) remains the same until the following December 31. You may only change or terminate your benefit elections during the Plan Year if you experience a qualified change in status.

Change in Status

If you have a qualified change in status, you must make any eligible changes to your elections within 30 days of the event by contacting Human Resources at 1-888-287-4369. Otherwise, you must wait until the next annual enrollment period.

As long as you meet the 30-day deadline, the new elections you make will generally take effect on the first of the month following 30 days from the qualified event. Special provisions apply for medical and dental coverage when the change in qualified status is:

Your marriage, or
The birth of your child or a child’s placement for adoption with you.

See “When Coverage Begins” in the Health Care Benefits section for details on these special provisions.

Generally, a qualified change in status includes:

any event that changes your legal marital status, such as marriage, divorce, legal separation, annulment, or the death of your spouse,
any event that changes the number of your eligible dependents, such as birth, adoption, placement for adoption, or the death of your dependent,
any event that changes your employment status or the employment status of your spouse or dependent, such as termination or beginning of employment, beginning or end of an unpaid leave, change in worksite, or change of employment classification (for example, part-time to full-time or vice versa),
any event that changes dependent status (for example, age), or
a change in residence for you or your spouse or dependent (for example, if you are enrolled in a Medical Plan or Dental Plan and you move out of the network service area).

For the Dependent Care Flexible Spending Account (DCFSA), the qualified change in status must affect eligibility for coverage under the DCFSA or eligibility of dependent care expenses for the available tax exclusion. For example, when your child reaches age 13, dependent care expenses are no longer eligible for reimbursement.

Consistency Requirements

The changes you make to your medical, vision, dental, dependent care flexible spending account and health care flexible spending account coverage must be “due to and consistent with” your qualified change in status. To satisfy the “consistency rule,” your qualified change in status and corresponding change in coverage must meet both of the following requirements:

Effect on eligibility: Except for the Dependent Care Flexible Spending Account, the qualified change in status must affect eligibility for coverage under the plan or under a plan sponsored by the employer of your spouse or other dependent. For this purpose, eligibility for coverage is affected if you become eligible (or ineligible) for coverage or if the qualified change in status results in an increase or decrease in the number of your dependents who may benefit from coverage under the plan.
Corresponding election change: The election change must correspond with the qualified change in status. For example, if your dependent loses eligibility for coverage under the terms of the health plan, you may cancel medical coverage only for that dependent. The plan administrator, in its sole discretion and on a uniform and consistent basis, shall determine whether a requested change is on account of and corresponds with a qualified change in status.

You may also be able to change your benefit elections due to certain other events during the Plan Year, such as the following:

A significant increase in the cost of similar coverage under your spouse’s or dependent’s employer’s plan. This change does not apply to your Health Care Flexible Spending Account.
A loss of similar coverage for your spouse or dependent under another employer’s plan.
If a benefit option is added during the year, you may be able to change your election to elect the new option.
If a benefit option is dropped during the year, you may be able to elect another option with similar coverage.
If there is a “significant curtailment” of your coverage, you may be able to change your election and elect another option with similar coverage. “Significant curtailment” may mean, for example, the elimination of hospital/physician networks or specialty vendors. “Significant curtailment” may also be based on plan design changes. This change does not apply to your Health Care Flexible Spending Account.
If there is a significant change in the cost of coverage, plan design, or benefit options under your spouse’s or dependent’s employer’s plan, you may be able to make a corresponding election change under MPTN’s Plan (for example, you may drop coverage under your spouse’s plan and elect coverage under MPTN’s Plan if the cost of coverage under your spouse’s employer’s plan significantly increases). The change in cost provision applies to Dependent Care Flexible Spending Account benefits only if the cost change is imposed by a dependent care provider who is not your relative. This change in cost provision does not apply to your Health Care Flexible Spending Account.
You may be able to drop coverage under MPTN’s Plan for yourself or your spouse or dependents to elect similar coverage under your spouse’s employer’s plan.
If the MPTN Team Member Benefit Plans receive a judgment, decree or order, including a Qualified Medical Child Support Order (QMCSO), requiring the plan to provide accident or health coverage to your dependent child. In this instance, the plan will automatically change your benefit elections to provide coverage for the child. You may decrease your coverage for that child, if the court order requires the child’s other parent to provide coverage and your spouse’s or former spouse’s plan actually provides that coverage. This change does not apply to the Dependent Care Flexible Spending Account.
If you, your spouse or dependent becomes entitled to, or loses entitlement to coverage under a U.S. government institution, Medicare, Medicaid, or a state children’s health program, you may make corresponding changes to your benefit elections under the MPTN Team Member Benefit Plans. This change does not apply to the Dependent Care Flexible Spending Account.

You may change your Dependent Care Flexible Spending Account elections during the Plan Year under the following circumstances:

If another employer’s Dependent Care Flexible Spending Account allows for a change in your family member’s coverage (either during that plan’s annual enrollment period or due to a mid-year election change permitted under the U.S. Internal Revenue Code), you may be able to make a corresponding election change under the dependent care flexible spending account.

If there is a change by your dependent care service provider. For example: (i) if you terminate one dependent care service provider and hire a new service provider; and (ii) if you terminate a dependent care service provider because a relative becomes available to take care of the child at no charge, then you may cancel coverage.

Other Rules

Special Enrollment Events: You have special enrollment rights under certain circumstances. If you are declining enrollment for yourself or your dependents (including your spouse) because of other health insurance coverage, you may in the future be able to enroll yourself or your dependents for medical, vision and dental coverage, provided that you request enrollment within 30 days after your other coverage ends. 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, provided that you request enrollment within 30 days after the marriage, birth, adoption, or placement for adoption. If you miss the 30-day deadline, you will have to wait to enroll until the next annual enrollment period — or for another qualified change in status or another special enrollment right.

Written Documentation

To meet Internal Revenue Service regulations and plan requirements, the plan reserves the right at any time to request written documentation of any dependent’s eligibility for plan benefits and/or the effective date of the qualified change in status.

The plan administrator will determine whether a requested change is due to a qualified change in status event and is on account of and consistent with the event.

Qualified Medical Child Support Order (QMCSO): A QMCSO is any judgment, decree, or order (including a settlement agreement or administrative notice), issued by a domestic relations court or other court of competent jurisdiction, or through an administrative process under tribal or state law which has the force and effect of law in that jurisdiction, and meets the requirements of TERISA.

If you are required to provide medical, vision and/or dental care coverage to your child who is your dependent as the result of a judgment, decree or order (including a QMCSO), the plan will automatically change your benefit elections to provide coverage for the child. In the case of a child whom you are required to cover pursuant to a QMCSO, coverage will begin on the date specified in the order, or if none is specified, the date of the order. You may decrease your coverage for that child, if the court order requires the child’s other parent to provide coverage and your spouse’s or former spouse’s plan actually provides that coverage. You also may make other corresponding changes to your benefit elections under the plan, to the extent permitted by the Internal Revenue Code and the plan. If a judgment, decree, or order (including a QMCSO) requires you to provide health care coverage for a dependent, you may adjust your health care flexible spending account contributions accordingly.

Medicare or Medicaid Entitlement

You may change an election for medical coverage mid-year if you, your spouse, or your eligible dependent becomes entitled to, or loses entitlement to, coverage under Part A or Part B of Medicare, or under Medicaid. However, you are limited to reducing your medical/dental coverage only for the person who becomes entitled to Medicare or Medicaid, and you are limited to adding medical/dental coverage only for the person who loses eligibility for Medicare or Medicaid. If your spouse or dependent becomes covered by Medicare or Medicaid, your Health Care Flexible Spending Account coverage may be canceled completely.