Current through August, 2024
(a) Except as otherwise provided in this
chapter, once an eligible employee has elected benefits under the plan and the
plan year has begun, the eligible employee may not change or cancel the elected
benefits unless authorized under the Code and if on account of a change of
status described in 26 Code of Federal Regulations § 1.125-4(c), the
change or cancellation is necessitated by and is consistent with a change in
status.
(b) Examples of a change in
status authorized under the Code include, without limitation:
(1) A change in legal marital status
(including marriage, death of a spouse, divorce, legal separation, or
annulment);
(2) A change in the
number of dependents (including birth, adoption, addition of a foster child,
death of a dependent. placement for adoption, or the joining of eligible
dependents to the employee's household);
(3) A change in employment status of the
employee, the employee's spouse, or the employee's dependent, (including
commencement or termination of employment, a strike or lockout, reduction or
increase in hours of employment by the employee, spouse, or dependent,
commencement of or return from an unpaid leave of absence, transfer to a
non-eligible employment classification, a change to a new employment
classification where other component plans are available or where the
employee's carrier's plan is not available, or a change in
worksite),'
(4) A change that
causes an employee's dependent to satisfy or cease to satisfy eligibility
requirements for coverage (including attaining age, student status, or any
similar circumstance); or
(5) A
change in residence of the employee, spouse, or dependent (including moving
from the geographic area covered by the employee's carrier's plan or moving
into an area where other component plans are available).
(c) Examples of other changes permitted under
the Code include, without limitation;
(1) A
change to conform to a judgment, decree, or order;
(2) A change because the employee becomes
entitled to Medicare or Medicaid coverage;
(3) A change allowed because of a special
requirement relating to the Family and Medical Leave Act; or
(4) For the dependent care expense
reimbursement spending account, a dependent becoming or ceasing to be a
qualifying dependent as defined under section 21(b) of the Code and the
availability or a significant cost change of a qualified dependent care
services provider shall also qualify as changes in status; provided the cost
change is imposed by a dependent care services provider who is not related to
the participant, as defined in section 152(a) (1) through (8) of the
Code.
(d) To change or
cancel elected benefits, a participant shall submit a written request on a form
prescribed by the director to the third-party administrator fully describing
the change in status, within ninety days of the change in status.
(1) An allowable change in elected benefits
shall be effective on the first day of the month following the third-party
administrator's receipt and approval of the required forms.
(2) The cancellation of elected benefits or
an election of new benefits may be made by a participant only for the remainder
of the plan year, and shall be effective prospectively, and shall be done in
accordance with this chapter. An allowable cancellation of elected benefits
shall be effective on the last day of the month following the third-party
administrator's receipt and approval of the required forms.
