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County of Sonoma, California

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Change of Status & Allowable Mid-Year Enrollment Changes

Below is a brief summary of some of the more common change of status events and the mid-year enrollment changes employees can make to their health plan (medical, dental and/or vision).

Change of status or eligibility changes permitted in accordance with Section 125 of the Internal Revenue Code1.

This chart is only a summary of some of the permitted health plan changes and is not all inclusive.

Life / Family Events
If you experience
the following Event...
You may make the following change(s)2
within 31 days of the Event...
You may not make these types of changes...
Marriage or Commencement of Domestic Partnership (DP)
  • Enroll yourself, if applicable
  • Enroll your new spouse/DP and other eligible dependents
  • Drop health coverage (to enroll in your spouse/DP’s plan)
  • Change health plans
  • Drop health coverage and not enroll in spouse/DP’s plan.
Divorce/Legal Separation or Termination of Domestic Partnership
  • Drop your spouse/DP from your health coverage
  • Enroll yourself and your dependent children if you or they were previously enrolled in your spouse/DP’s plan
  • Change health plans
  • Drop health coverage for yourself or any other covered individual
Gain a child due to birth or adoption
  • Enroll yourself, if applicable
  • Enroll the eligible child and any other eligible dependents
    • Adoption placement papers are required
  • Change health plans
  • Drop health coverage for yourself or any other covered individuals
Child requires coverage due to a Qualified Medical Child Support Order (QMCSO)
  • Add child named on QMCSO to your health coverage (enroll yourself, if applicable and not already enrolled)
  • Change health plans, when options are available, to accommodate the child named on the QMCSO
  • Make any other changes, except as required by the QMCSO
Loss of a child’s eligibility (e.g., child reaches the maximum age for coverage or is no longer a full-time student (dental and/or vision coverage)
  • Drop the child who lost eligibility from your health coverage
  • Child will be offered COBRA .
  • Change health plans
  • Drop health coverage for yourself or any other covered individuals
Regain eligibility (e.g. full-time student (dental and/or vision coverage)
  • Add child who regained eligibility to your dental and/or vision coveragex
    • Documentation of full-time student status is required
  • Add any additional eligible dependents to your dental or vision coverage
Death of a dependent (spouse/DP or child)
  • Drop the dependent from your health coverage
  • Change health plans
  • Drop health coverage for yourself or any other covered individuals
Covered person has become entitled to (or lost entitlement to) Medicare, Medicaid, Medi-Cal or SCHIP2
  • Drop coverage for the person who became entitled to Medicare, Medicaid, Medi-Cal, or SCHIP
  • Add the person who lost entitlement to Medicare, Medicaid, Medi-Cal, or SCHIP
    • Documentation required
  • Drop health coverage for yourself or any other covered individuals who are not newly Medicare, Medicaid, Medi-Cal, or SCHIP eligible.
Change of home address outside of plan service area
  • If you are enrolled in an HMO and move out of their service area, then you can elect new coverage
  • Does not apply to County Health Plan, dental or vision coverage
Employment Status Events
If you experience
the following Event...
You may make the following change(s) within 31 days of the Event... You may not make these types of changes...
You become newly eligible for benefits due to change in employment status or bargaining group
  • Enroll yourself, if applicable
  • Enroll your spouse/DP and other eligible dependents
  • Drop health coverage
  • Drop your spouse/DP and other eligible dependents
  • Change health plans
  • Enroll, drop or change plans if your employment change does not result in you being eligible for a new set of benefits
Spouse/DP obtains health benefits in another group health plan
  • Drop your spouse/DP from your health coverage
  • Drop your dependent children from your health coverage
  • Drop coverage for yourself
    • Proof of coverage in the other health plan required
  • Change health plans
  • Add any eligible dependents to your health coverage
Spouse/DP loses employment, experiences a termination of their employer’s contribution, or otherwise loses coverage for health benefits in another group health plan You or your dependents exhaust COBRA coverage under other group health plan
  • Enroll your spouse/DP and, if applicable, eligible dependent children in your health plan
  • Enroll yourself in a health plan if previously not enrolled because you were covered under your spouse/DP’s plan
  • Change health plans
    • Proof of loss of other coverage is required
  • Drop health coverage for yourself or any other covered dependents
You lose employment or otherwise become ineligible for health benefits
  • Enroll in your spouse/DP’s plan, if available
  • Elect temporary COBRA coverage for the qualified beneficiaries (you and your covered dependents)
 
You experience a reduction in hours that results in a significant cost increase or an unpaid leave not covered by FMLA, CFRA etc. where the County will no longer be making a contribution
  • Drop your spouse/DP from your health coverage
  • Drop your dependent children from your health coverage
  • Drop coverage for yourself
  • Change health plans to a less expensive plan
  • No change is allowed unless the reduction in hours causes a loss of eligibility or a loss or significant reduction of the employer subsidy for medical (not FSA) coverage. Financial hardship (including due to a pay cut or reduction in hours) does not trigger the change in cost rule.
You experience an increase in hours (e.g. part-time to full-time) that results in a significant cost decrease or return from an unpaid leave (e.g. leave without pay) when the County was not making a benefit contribution
  • Add coverage for yourself
  • Add your spouse/DP, or dependent children to your health coverage
  • Change health plans
  • No change is allowed unless the increase in hours results in new eligibility or a significant change in the employer subsidy for medical (not FSA) coverage.
You return from Military leave
  • Enroll yourself, if applicable
  • Enroll your spouse/DP and other eligible dependents
  • Change health plans
 

Notes:

  1. Rules above apply equally to IRS qualified and non-qualified dependents for consistency and ease of administration.
  2. Have 60 days from loss or eligibility determination of Medicare, Medicaid, Medi-Cal or SCHIP to request special enrollment.

Effective Dates

The above benefit election changes are effective as follows:

  • Canceling Coverage: Effective date of change is generally the last day of the month after the event that allowed the change.

    E.g., Spouse obtains other group coverage on the 1st of the month. Coverage for spouse ends on the last day of the prior month.

  • Adding new/changing coverage: Effective date of change is generally the first of the month following or coinciding with the event that allowed the change.

    E.g., Married on the 1st of the month. Coverage for new spouse is effective on the 1st of the same month.

    Married on the 2nd of the month. Coverage for new spouse is effective on the 1st of the following month.

  • New Hires: Effective on the 1st of the month following date of hire.

    E.g., Hired June 1, 2010. Coverage is effective on July 1, 2010.

    Hired June 9, 2010. Coverage is effective July 1, 2010.

Effective Date Exceptions:

  • Birth/Adoption: Effective on the 1st of the month following date of birth/adoption. Medical plans will cover a newborn under the subscriber’s coverage from date of birth through the end of the birth month. Submit paperwork to your payroll clerk or Human Resources early and no later than 31 days from the date of birth to ensure medical coverage for the child.
  • Return from Military Leave: Effective on the date you return to work.

Contact Information

Name:
County of Sonoma Human Resources Benefits Unit
Phone:
(707) 565-2900 Work
Email:

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