Status Change Must Be Submitted to Your HR Department Within 30 Days Of The Event

You may request a change in your election to revoke the existing plan election and make a new election for the remainder of the plan year. Please complete the Status Change Form and submit to your Human Resources Department within 30 days of the change in your status. The Human Resources Department will review your request and make a determination as to whether the request is appropriate in accordance with the regulations.

The later of the Election Date or the Date of Status Change is the date used for the effective date of the change. The date the election change goes into effect must be prospective. Retroactive elections are not allowed.

There must be a change in eligibility created by the status event indicated below for a change in election to be allowed in accordance with the IRS Consistency Rule.

Change in legal marital status: Events that change an employee's legal marital status, including the following: marriage, death of a spouse, divorce, legal separation, and annulment.

Number of Dependents: Events that change an employee's number of dependents including the following: birth, death, adoption, and placement for adoption. A dependent is formally defined to be a tax dependent under Code Section 152. This rule would not allow election changes for non-tax dependents such as parents, domestic partners and children of domestic partners.

Dependent Satisfies or Ceases to Satisfy Eligibility Requirements: Events that cause an employee's dependent to satisfy or cease to satisfy eligibility requirements for coverage on account of attainment of age, student status or any similar circumstance.

Employment Status: Any of the following events that change the employment status of the employee, the employee's spouse or the employee's dependent: a termination or commencement of employment; a strike or lockout; a commencement of or return from an unpaid leave of absence; and a change in worksite. Also included is if an employee switches from salaried to hourly-paid with the consequence that the employee ceases to be eligible for the plan.

Other Allowed Change Events

Change in day care provider

Change in cost of day care provider Does not apply when the day care provider is a relative