Life Events

Eligibility status changes:

• Marital change due to marriage, divorce, or death of spouse
  
• Birth or adoption of a child
• Formal (DPT-approved) preadoptive agreement when the child resides with the employee
• Dependent becomes ineligible for the employee's health benefits plan (for example, reaches dependent age limit)
• Loss of spouse's health benefits covered due to termination of employment, or due to spouse's employer discontinuing the health benefits program (this applies to the loss of coverage by the other biological or adoptive parent under the same circumstances, as well.)
• Termination or commencement of employment by the employee's spouse
• Employee or employee's spouse changes from part-time to full-time employment, or from full-time to part-time employment
• Employee or dependent becomes eligible or ineligible for a government-sponsored health benefits program
• Department of Social Services, Division of Child Support Enforcement, requires the employee to cover a dependent by way of a Health Care Coverage
• Order issued to the employing agency
• A court orders the eligible employee to assume permanent custody of an "other"; child - one who is not a biological, adoptive, or stepchild
• You move out of your plan's service area (You may change to another plan only. You may not change your type of membership, unless it coincides with a qualifying status change listed above.)
• Employee or spouse taking an unpaid leave of absence
• Transition from short term disability to long term disability under the Virginia Sickness and Disability Program

An employee has 31 days from the date of a status change to modify the agency benefits administrator in order to effect a change.

Change of Address - When an address change occurs contact Human Resources at 568-3970 or complete the address change form. It is important to keep your address current to receive agency and Trigon mailings.

Marriage - When an employee marries and wants to add the spouse, the employee must enroll through the interactive voice response system or submit an Enrollment Form for Employee Plus One or Family Membership within 31 days of the marriage. Coverage will be effective the first of the month after the month in which they were married. If enrollment does not occur within 31 days of the marriage, the employee may apply for Employee Plus One or Family Membership using the floating enrollment option, provided no changes have been made within the last 12 months. If the employee already has Family membership and marries, the spouse may be added even after 31 days. However, the spouse should be added immediately to avoid claims denials or reductions in coverage for non-selection of a PCP.

Change of Name - When a name change occurs contact HR so that records may be updated. A copy of the social security card with correct name will be required. It is important to keep your HR office informed of name changes.

Divorce - When a divorce occurs, the spouse is covered on the employee's membership only until the end of the month in which the divorce becomes final. Human Resources must be notified within 31 days of the divorce. The employee must provide a copy of the final divorce decree. The ex-spouse will be notified of the coverage ending and offered extended coverage.

Birth Of A Child - The employee Contacts HR within 31 days after the birth of a child. Employee Plus One or Family membership will be effective the first of the month in which the baby is born.

Adoption Of A Child - A child who, at birth or at a later time, is either adopted by a State employee or who resides with the employee under the authority of a formal pre-adoptive agreement will be eligible for health benefits in a manner identical to a biological child of an eligible employee. Within 31 days of the pre-adoptive placement or adoption effective date, the employee should take action to cover the adoptive child. Department of Personnel and Training (DPT) must determine that a pre-adoptive agreement meets uniform eligibility standards. A child who, within 31 days of birth, is adoptive or is living with the employee under a formal pre-adoptive agreement (which has been approved by DPT for the purpose of affirming eligibility), will be eligible for coverage, effective the first of the month in which the birth occurred. If child is more than 31 days old when adoption is final, insurance effective 1^st of the month following date of final adoption. Example: If the adoption papers are dated August, insurance would be effective September 1.

Custody - When an employee gains permanent custody of a dependent such as a grand child, niece, nephew or other child, that dependent's status must be approved by the Department of Personnel and Training before they can be added to the employee's health insurance. A copy of the court document awarding custody will be forwarded to DPT for approval. You must contact Human Resources with in 31 days of gaining custody. If approved coverage will be effective the first of the month after the date of being awarded custody.

Child Who Marries - Coverage for a dependent child stops at the end of the month in which the child marries. If the employee no longer needs Employee Plus One or Family membership, the employee should call the interactive voice response system to reduce membership, or submit an Enrollment Form for Single membership within 31 days of marriage.

When a child loses coverage because he or she no longer is eligible, the child may enroll in Extended Coverage or non-group coverage with the health benefits plan in which he or she has been enrolled. The employee or the child must contact the agency Benefits Administrator within 60 days of the loss of coverage for Extended Coverage to be offered, or must contact the health benefits plan to arrange for non-group coverage.

Child Losing Eligibility - Under Key Advantage and Cost Alliance, eligible children may be covered until the end of the calendar year in which they turn age 23, regardless of student status, if the child is not self-supporting. If the child becomes self-supporting, or otherwise ineligible, coverage will end on the last day of the month in which he/she become ineligible. When children lose coverage because they are no longer eligible, it is possible to apply for Extended Coverage or non-group coverage with their health benefitsplan.

A child who is employed full time will be considered self-supporting, regardless of where the child resides. Full-time employment is defined as what the employer considers full time. The only exception regarding a child who works full time is the child who works full time during only the summer months and was a student through spring semester and will be a student in the fall, when full-time employment will cease.

NOTE: An employee's failure to remove ineligible persons from his or her health benefits membership can result in retraction of claims and other penalties.

If the employee wishes to reduce his or her membership from Employee Plus One or Family after a child becomes ineligible, it is up to the employee to take action to enroll in the lesser membership the month before the change is needed or not later than 31 days after the change.

Death in a Family - The employee must contact HR to remove a deceased family member within 31 days of the death. If membership is reduced due to the death of such as from family coverage to employee and one or plus one or employee plus one to single coverage. The change will be effective the first of the month following the month of the death.

Retirement - Retirees may maintain their health insurance upon retirement. The Virginia Retirement System administers benefits for the majority of state retirees.

To be eligible for the state's retiree group, the person must be retired and eligible for a monthly benefit from VRS or another qualified optional retirement plan such as TIAAA-CREF, Fidelity, etc. Dependents may also be covered under the retiree's plan. Coverage in the retiree group begins on the first day of the first full month of retirement. To assure a smooth transition from active coverage to retiree coverage, contact your HR office at least 3 months prior to retiring for assistance.