Qualifying Events

Federal Government regulations generally require that plan coverage remains in effect, without change, throughout the plan year, but some changes may be made during the year (mid-year) if PEBP determines that a qualifying event affecting health benefits exists. Any change made to healthcare benefits must be determined by PEBP to be necessary, appropriate to, and consistent with the change in status. The plan must be notified in writing within 60 days of the qualifying event; otherwise, the request will not be accepted and the change will have to wait until the next Open Enrollment. As a result of a qualifying event, only those changes that are consistent with the change of status will be allowed. Generally, only coverage for an individual who has lost eligibility from a group health plan as a result of a change of status (or who has gained eligibility from a group health plan and actually enrolled in that coverage) can be added or dropped mid-year from this Plan. Any qualifying event that creates a situation in which the retiree/survivor and all remaining covered dependents are eligible for free Medicare part A, creates a requirement that the retiree/survivor and all remaining covered dependents choose coverage through the Medicare Exchange. Any individual under this requirement who does not choose coverage through the Medicare Exchange will lose coverage.

Coverage changes associated with a mid-year change of status opportunity are effective on the first day of the month concurrent with or following the event date that caused the change of status opportunity, except for newborns who are effective on the date of birth, and children adopted or placed for adoption, who are effective on the date of adoption or placement for adoption.

Additional information on qualifying events can be viewed at PEBP's Qualifying Life Status Events Document:
Qualifying Life Status Events, Updated February 2017

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