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Change in Status/Qualifying Events

In order for the state to maintain employee contributions with pre-tax earnings, any changes made outside of open enrollment must be in compliance with the applicable change in status event rules of the Internal Revenue Code, Section 125.  You may request for coverage change for the following change in status events:

1. After marriage, death of a dependent, divorce, legal separation, or annulment, in which case coverage becomes effective the first day of the month following the month of the event.
 
2. Birth, adoption or placement for adoption in which case the coverage change becomes effective as of the date of birth, adoption, or placement of a child.

3. Termination or commencement of employment of a spouse or dependent that results in the loss or gain of eligibility, in which case coverage becomes effective the first day of the month following the month of the event.
 
4. Reduction or increase in hours of employment by the employee (including layoff or reinstatement from layoff), spouse, or dependent, including a switch between part-time and full-time, strike, lockout, or commencement, return to work from an unpaid absence, or change in work site in which case coverage becomes effective the first day of the month following the month of the event.
 
5. Return to work through order of arbitration or settlement of a grievance, or any administrative body with authority to order the return to work of an employee.
 
6. The employee’s dependent satisfies or fails to satisfy the requirement of the definition of dependent due to attainment of age or any similar circumstance as provided in the health plan under which the employee receives coverage.
 
7. If the plan receives a Qualified Medical Child Support Order (QMCSO) pertaining to an employee’s dependent, the employee may elect to add or drop the child to the plan depending upon the requirement of the QMCSO.
 
8. If an employee, spouse, or dependent who is enrolled in a health plan becomes entitled to coverage (i.e., enrolled) under Part A or Part B of Title XVIII of the Social Security Act (Medicare) or Title XIX of the Social Security Act (Medicaid), other than coverage consisting solely of benefits under Section 1928 of the Social Security Act (the program for distribution of pediatric vaccines).
 
9. If an employee, spouse, or dependent is no longer entitled to coverage (i.e., enrolled) under Part A or Part B of Title XVIII of the Social Security Act (Medicare) or Title XIX of the Social Security Act (Medicaid), other than coverage consisting solely of benefits under Section 1928 of the Social Security Act (the program for distribution of pediatric vaccines).
 
10. The employee no longer resides in the service area of their current medical TPA.

If your change in status/qualifying event is birth, adoption, marriage, or divorce you may change your health benefits coverage online through myBenefits at myohio.gov.  For all other change in status/qualifying events, you must submit completed paper enrollment form(s) to your agency for processing.  All required documentation and forms must be submitted to your agency within 31 days of the change in status/qualifying event, regardless if you submitted your change via eBenefits or paper forms.

The 31 day deadline may be extended if the delays in receiving certain required documents (birth certificate, marriage certificate) are outside of your control.  If you anticipate a delay in receiving the required documents, you must initiate the change in status request by submitting all documentation that you have available within 31 days of the change in status event.  A valid reason must be provided with your submission as to why certain document is missing along with the estimated date it will be available.  Any missing documentation must be submitted within 31 days of receipt.  Proof of date of receipt, such as postmark date of the document, will be required.

Click here to access the list of required documentation and forms for processing change in status event changes for medical, dental and/or vision coverage. 

 

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