Life Events: What to do to Change, Add, or Cancel Your Benefits
If you experience a life event – like marriage, a birth, divorce, death or change in employment – you may change your health and/or dental benefits and participation in the Flexible Spending Account (FSA) program. You must notify the Benefits office and complete your ESS life event to change your benefits enrollment within 30 days of the qualifying event.
These life events are also called status changes or qualifying events. They are detailed in the Regulations for Section 125 of the Internal Revenue Code governing plans.
The following events are examples of Section 125 status changes or qualifying events:
- Loss of health coverage
- A move that causes loss of eligibility
- A significant cost change, a significant coverage curtailment, a significant improvement, a new option, or a change in coverage under your, your spouse’s or your dependent’s plan
- Entitlement to or loss of Medicaid
- Entitlement to Medicare
- Marriage or divorce
You may not drop coverage for a spouse if you are legally separated; you may drop coverage upon your divorce.
- Changing from a full-time to a part-time position or a part-time to a full-time position
- Beginning or returning from an unpaid leave of absence
- Spouse’s or other dependent’s change in employment status that affects his or her eligibility for medical and/or dental benefits
- Death of a spouse
- Birth or placement of a child for adoption
- Becoming the legal guardian of a child
- A court order requiring you to cover a child or an order requiring someone else to cover your dependent
- Dependent reaching age 26 if enrolled under SCPS insurance policy
- Death of a child
The 30-Day Rule
If you are a new employee, you must enroll for health, dental and FSA benefits within 30 days of your contract date. Late enrollment is not allowed.
If you are a current employee, you have 30 days from the date of a status change or qualifying event to change your health, dental and FSA benefits. Most benefit changes take effect on the first of the month following the event, except for a birth or adoption placement, if notification is in accordance with established monthly payroll processing deadlines. (See page 30 for list of monthly processing deadlines.)
- Coverage for a birth takes effect on the first of the month when the baby is born.
- Coverage for an adoption placement takes effect on the first of the month in which the child is placed with you or the first of the month in which you receive a formal legal document stating that you are responsible for the child’s health coverage. As an adoptive parent, you do not have to wait until the adoption is final to add your child to your health plan.
- Your participation in the FSA program takes effect on the first day of the month following your employment date or the first of the month in which you receive a paycheck, if appropriate paperwork has been submitted.
- You are married April 13 and you add your spouse to your health plan on May 5. Your spouse’s coverage takes effect June 1.
- You have a baby on May 7, and you add your baby to your health plan on May 19. Your baby’s coverage begins on May 1. (New babies are added retroactively.)
- Your baby is placed with you for adoption on September 20, and you add him or her to your health plan on September 29. His or her coverage begins on September 1.
It is your responsibility to inform the Payroll & Benefits Office about a status change by completing an ESS Life Event . You must also provide written proof of the change in eligibility for situations other than the birth of a new baby.
If you fail to notify SCPS within the 30-day period, you may not enroll, cancel, or change coverage until Open Enrollment.
If you miss the 30-day deadline for a status change or qualifying event that results in the cancellation of coverage or a reduction in your employee contribution (like a divorce or your child turns 26), SCPS will not refund your contributions.
Life Events and the 30-Day Rule
- If you marry, you may change your enrollment as an individual, employee plus spouse, or family.
- If you divorce, you may change your enrollment as an individual, employee plus child or employee plus children. Once you are divorced, your former spouse no longer qualifies for SCPS health/dental insurance. A separation agreement is not a legal event in Virginia, and you cannot drop your spouse due to a separation.
In addition to submitting an ESS Life Event, you must also provide documentation of the event.
- If you and your spouse have a baby, adopt a baby, or gain legal guardianship of a child, you can add the new dependent and change to family, employee plus child, or employee plus children coverage.
- If you have a child and participate in the Dependent Care Flexible Spending Account (FSA) plan, and you add a new child to the family, you may increase or cancel your dependent care account contribution.
- If your son or daughter “ages out”- that is, the month he or she turns age 26 – he or she is no longer eligible for SCPS coverage as a dependent.
Required documentation includes:
- Adoption papers or legal papers indicating placement for adoption
- Court order regarding legal guardianship of a child
- Marriage certificate stating date of marriage
- Divorce decree signed by the judge (applicable pages)
- Death certificate
- Letter from your spouse’s or dependent’s Human Resources Department or insurance plan with insurance cancellation date
- Letter from your spouse’s or dependent’s Human Resources Department or insurance plan explaining circumstances regarding a significant cost change (min. 35% change), a significant coverage curtailment, a significant improvement, a new option or a change in coverage
- Court order requiring you to cover a child or an order requiring someone else to provide coverage for your dependent
- Copy of your Medicaid card
You must notify the Payroll & Benefits Office and complete your ESS Life Event to change your benefits enrollment within 30 days of an employment change that meets the criteria of a qualifying event:
- If you are enrolled through a health plan with your spouse’s employer and your spouse loses coverage, you and your family may enroll in an SCPS plan
- If your spouse’s new employer offers health benefits and you join your spouse’s plan, your eligibility for that plan will allow you to cancel your SCPS coverage
- If you return to active employment from a leave of absence and are eligible for benefits, you must enroll within 30 days.
*All changes must be made prior to end of fiscal year payroll processing deadline (June 15th for 10- and 11-month employees) per policy and regulation 4705-R.