Change of Status Summary (pdf) - a brief description on change of status regulations.
What is a qualified Change of Family Status?
- Legal marriage, qualified domestic partnership
- Divorce, annulment, legal separation, or dissolution of domestic partnership
- Death
- Birth, adoption, or legal custody
- Child becomes or is no longer an eligible dependent
- Changes in employment status
- Any benefit changes must be consistent with the Change of Family Status that occurred and be supported by required documentation.
- If family coverage is already elected, new dependents must be added individually.
Change of Status Deadlines
- The change of family status form, with the required documentation, must be received in the Benefits Department within thirty (30) days from the date the qualifying event takes place.
- Changes will become effective on the first day of the month following the date the change occurred.
For example - Marriage - October 17th. Paperwork must be received by November 17th. Changes would take effect November 1st.
Note: Changes between plans such as Buy-Up to Core and/or PPO to Prepaid dental may only be done during Open Enrollment.
Dependents and Change of Family Status Rule
- Only qualified dependents are eligible for coverage under your benefit plans provided by the District.
- Qualified dependents include your spouse or domestic partner and your married or unmarried children, stepchildren and adopted children under of 26.
- Excluded from the benefit coverage provided by the District are brothers, sisters, parents, grandparents, grandchildren, aunts, uncles, ex-spouses, ex-partners, children of ex-spouses and ex-partners.
- However, medical support orders for qualified children may qualify for eligibility.
Special Enrollment Rights
Effective April 1, 2009, special enrollment rights apply in accordance with the Children's Health Insurance Program Reauthorization Act of 2009, which funds and expands the State Children's Health Insurance Program (SCHIP). The rights will apply if 1) you or your dependents experience a loss of eligibility for Medicaid or your SCHIP coverage; or 2) you or your dependents become eligible for premium assistance under an optional state Medicaid or SCHIP program that would pay the employee's portion of the health insurance premium. In order to be entitled to the special enrollment right, the employee must request coverage within 60 days of coverage termination or the date the parent or child is determined to be eligible for assistance.
The Medicaid and Children's Health Insurance Program (CHIP) premium assistance notification is available here (pdf).
Accountability
It is a fraudulent practice to add ineligible dependents to the District provided benefit coverage. Insurance fraud is generally defined as the "intentional misrepresentation of material facts and circumstances to an insurance company to obtain payment that would not otherwise be made." It is fraudulent to fail to notify the Benefits office of a change in status or to misrepresent dependents in any manner. Disciplinary action will be taken, up to and including termination, should this occur.