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Mid Year Changes

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If you waive coverage or do not enroll within 31 days of your date of hire, you may be able to join the State Plan at a later date, but you will only be eligible for Core Benefits for yourself. You will not be able to add a spouse/domestic partner or dependent child(ren) to the plan or elect optional benefits without a Special Enrollment Period.The following information provides State Plan requirements for mid-year changes.

Mid-Year Open Enrollment

An Employee who waives coverage may enroll other than during an Open Enrollment Period or Special Enrollment Period. An Employee who enrolls outside of the Open Enrollment Period or Special Enrollment Period is effective the first day following the receipt of the Employee Enrollment form. The Mid-Year Open Enrollment is available for eligible Employees only.

REQUIREMENTS FOR ADDING DEPENDENTS MID-YEAR

Special Enrollment Period

“Special Enrollment Period” means a period of time allowed under this Plan, other than the eligible person’s Initial Enrollment Period or an Open Enrollment Period, during which an eligible person may request coverage under this Plan as a result of certain events that create special enrollment rights.

In addition to other enrollment times allowed by this Plan, certain persons may enroll during the Special Enrollment Periods below described. Dependent verification is required. See “Dependent Verification of Eligibility Requirements” within ELIGIBILITY PROVISIONS for required documentation.

Coverage becomes effective as stated below for the following events if the Employee makes a special enrollment request, orally or in writing, within thirty (31) days of any special enrollment event and application for such coverage is made on the Plan’s Mid-Year Change form within sixty (60) days of the event.

1. An eligible Employee, Participant or Retiree, and all eligible Dependents acquired as a result of the event who are not enrolled may enroll and become covered on the first day of the first pay period under the following specific event:

A.Marriage to the Employee.

2. An eligible Employee, Participant or Retiree may enroll eligible Dependents who are acquired under the following specific events may enroll and become covered on the date of the event under the following specific events:

A. Birth of the Participant’s child; or

B. Adoption of a child by the Participant, provided the child is under the age of 18; or

C. Placement for Adoption with the Employee (must provide pre-adoption placement agreement), provided such Employee has a legal obligation for the partial or full support of such child, including providing coverage under the Plan pursuant to a written agreement and the child is under the age of 18.

3. The following individuals may enroll and become covered when coverage under another health care plan or health insurance is terminated due to loss of eligibility or if employer contributions to the other coverage have been terminated (Loss of Coverage), subject to the following:

A. If the eligible Employee loses coverage, the eligible Employee who lost coverage and any eligible Dependents of the eligible Employee who also lost coverage may enroll and become covered.

B. If an eligible Dependent loses coverage, the eligible Dependent who lost coverage and the eligible Employee may enroll and become covered.

C. If an eligible Dependent of a covered Retiree loses coverage, the eligible Dependent who lost coverage may enroll and become covered.

Loss of Coverage means only one of the following:

 A. COBRA Continuation Coverage under another plan that has been terminated or the maximum period of COBRA Continuation Coverage under the other plan has been exhausted; or

B. Group or insurance health coverage that has been terminated as a result of termination of employer contributions* towards the other coverage; or

C. Group or insurance health coverage (includes other coverage that is Medicare) that has been terminated only as a result of a loss of eligibility for coverage for any of the following reasons:

1) Legal separation or divorce of the eligible Employee;

2) Cessation of Dependent status;

3) Death of the eligible Employee;

4) Termination of employment of the eligible Dependent;

5) Reduction in the number of hours of employment of the eligible Dependent;

6) Termination of the eligible Dependent’s employer’s plan;

7) Any loss of eligibility after a period that is measured by reference to any of the foregoing; or

8) Any loss of eligibility for individual or group coverage because the eligible Employee or Dependent no longer resides, lives or works in the service area of a HMO or other such plan.

*Employer contributions include contributions by any current or former employer that was contributing to the other non-COBRA coverage.

A Loss of Coverage does not occur if coverage was terminated due to a failure of the Employee or Dependent to pay premiums on a timely basis or coverage was terminated for cause.

4. Individuals may enroll and become covered under this Plan when coverage under Medicaid or any state children’s insurance program recognized under the Children’s Health Insurance Program Reauthorization Act of 2009 is terminated due to loss of eligibility, subject to the following:


A. A request for enrollment must be made either orally or in writing within sixty (60) days after this special enrollment event, and written application for such coverage must be made within ninety (90) days after such event.

B. If the eligible Employee loses coverage, the eligible Employee who lost coverage and any eligible Dependents of the eligible Employee may enroll and become covered.

C. If an eligible Dependent loses coverage, the eligible Dependent who lost coverage and the eligible Employee may enroll and become covered.

D. If an eligible Dependent of a covered Retiree loses coverage, the eligible Dependent who lost coverage may enroll and become covered.

5. Individuals who are eligible for coverage under this Plan may enroll and become covered on the date they become entitled to a Premium Assistance Subsidy authorized under the Children’s Health Insurance Program Reauthorization Act of 2009. The date of entitlement is the date stated in the Premium Assistance Authorization entitlement notice issued by the applicable state agency (CHIP or Medicaid). A request for enrollment, either orally or in writing, must be made within sixty (60) days after this special enrollment event, and written application for such coverage must be made in writing within ninety (90) days after such event.

Change in Status

If a Covered Dependent under this Plan becomes an eligible Employee of the State, the Covered Dependent may continue their coverage as a Dependent or elect to be covered as a Participant, but may not be covered as both a Dependent and a Participant.

If an eligible Employee who is covered as a Participant of this Plan ceases to be an Employee of the State, but is eligible to be covered as a Dependent under another Participant, the former Employee may elect to continue their coverage as a Dependent of such Participant.

Application for coverage due to a Change in Status must be made on the Plan’s Mid-Year Change form within sixty (60) days following the date the Employee becomes or ceases to be an eligible Employee.

REQUIREMENTS FOR REMOVING DEPENDENTS MID-YEAR

Dependent Termination

Each Covered Person, whether Participant or Dependent, is responsible for notifying the Plan Administrator, within sixty (60) days after loss of Dependent status due to death, divorce, legal separation or ceasing to be an eligible Dependent child. Failure to provide this notice may result in loss of eligibility for COBRA Continuation Coverage After Termination.

Coverage for a Dependent automatically terminates upon the earliest of the following dates, except as provided in any Continuation of Coverage Provision:

  1. On the last day of the month in which the Dependent ceases to be an eligible Dependent as defined in the Plan;
  2. On the last day of the month of the pay period in which the Participant's coverage terminates under the Plan;
  3. On the last day of the month in which the Participant ceases to be eligible for Dependent Coverage;
  4. The first day of the pay period for which the Participant fails to make any required contribution for Dependent Coverage;
  5. The date the Plan is terminated;
  6. The date the State terminates the Dependent's coverage;
  7. The pay period following the date the Participant dies, or the date following the date the Retiree or other self-pay Participant dies;
  8. The date following the date the Dependent dies;
  9. On the last day of the month in which the Plan receives the Plan’s Health Coverage Waiver Form for the Dependent whose coverage is to be terminated; or
  10. In the event notice of Dependent ineligibility is not received within sixty (60) days, on the first day of the month of the pay period in which notification of the Dependent’s ineligibility is received by the Plan.

Responsibility To Remove Ineligible Dependents

It is the member’s responsibility (Employee, Retiree, COBRA enrollee, or surviving spouse/domestic partner) to remove any Dependents that cease to be eligible from coverage within sixty (60) days of the date eligibility is lost. The Employee, Retiree, COBRA enrollee, or surviving spouse/domestic partner is responsible for repayment of any claim dollars paid out for an ineligible Dependent. Any excess benefit contributions paid for the ineligible Dependent are refunded if the notification is received by the Plan within sixty (60) days of the date eligibility is lost. Refunds will not be issued if notification was made after sixty (60) days of the date eligibility is lost. In the event of automatic coverage termination due to death or State Children’s Health Insurance Program (SCHIP) eligibility, contributions subsequently collected are returned as pre-tax or after-tax depending on which method was used to pay the contributions.

Contact HCBD for any questions and see benefits.mt.gov/forms for the Mid-year Change Form.