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Qualifying Events
Contact Human Resources as soon as possible, but no later than 30 days after the qualifying event to initiate any changes. It is necessary to provide documentation to Human Resources to substantiate the qualifying event and to establish the eligibility for, and the effective date of, the requested change within 30 days of the qualifying event.
As a result of your recent divorce, please update the following applicable information with Human Resources:
- Name and/or Address
- Emergency Contact
- Health Insurance Benefits
- Dental Insurance Benefits
- Life Insurance Beneficiary Designation
- Spousal Life Insurance Coverage
- Deferred Compensation Beneficiary Designation
- CalPERS Beneficiary Designation
- Flexible Spending Account Benefits
- Tax Withholding Forms
As a result of your recent marriage, please update the following applicable information with Human Resources:
- Name and/or Address
- Emergency Contact Card
- Health Insurance Benefits
- Dental Insurance Benefits
- Life Insurance Beneficiary Designation
- Spousal Life Insurance Coverage
- Deferred Compensation Beneficiary Designation
- CalPERS Beneficiary Designation
- Flexible Spending Account Benefits
- Tax Withholding Forms
As a result of your recent family addition, please update the following applicable information with Human Resources:
- Health Insurance Benefit
- Dental Insurance Benefit
- CalPERS Beneficiary Designation
- Life Insurance Beneficiary Designation
- Child Life Insurance Coverage
- Deferred Compensation Beneficiary Designation
- Flexible Spending Account Benefits
- Tax Withholding Forms
As a result of your dependent's upcoming or recent birthday, please update the following applicable information with Human Resources:
- Health Insurance Benefits
- Dental Insurance Benefits
- Child Life Insurance Coverage
The following guidelines determine dependent status:
- Dental - Up to 26 years regardless of marital or student status.
- Medical - Up to 26 years regardless of marital or student status.
As a result of the death which occurred in your family, please update the following applicable information with Human Resources:
- Health Insurance Benefits
- Dental Insurance Benefits
- Emergency Contact
- Life Insurance Beneficiary Designation
- Spousal/Child Life Insurance Coverage
- Deferred Compensation Beneficiary Designation
- CalPERS Beneficiary Designation
- Flexible Spending Account Benefits
- Tax Withholding Forms
Official Documentation
It is necessary to provide documentation to substantiate the qualifying event and to establish the eligibility for, and the effective date of, the requested change.
- Court documents for adoption, divorce, marriage, etc.
- Affidavit of Domestic Partnership
- Documentation on company letterhead including:
- Qualifying event date and type
- Name of individual(s) affected by a status change
- Name(s) of those covered on plan(s) and the effective date or termination date of other coverage
- Medical and/or dental coverage effective date or termination date (or other benefits, as applicable)
- Health Insurance Portability and Accountability Act of 1996 (HIPAA) "certificate of credible coverage" from your prior insurance plan.
- In addition to the HIPAA certificate, written documentation supporting the special enrollment event is required (i.e. birth certificate, marriage certificate, proof of termination).
Coverage Effective Dates
- Adding an Eligible Dependent -Dependents become eligible the first of the month after the qualifying event occurs.
- Removing a Dependent - Dependents are removed from coverage as of the last day of the month in which the qualifying event occurs.
- Coverage Cancellation - Coverage terminates as of the last day of the month in which the qualifying event occurs.
- Adding Coverage - Coverage begins as of the first of the month after the qualifying event.