IRS Rules Around Qualifying Events
Generally, elections for group health insurance are irrevocable for the plan year under Section 125 plans, however the IRS provides specific instances when an employee can make a midyear election change. There are four main types of qualifying life events:
Loss of other health coverage
- Loss of existing health coverage, including job-based, individual and student plans
- Loss of eligibility for Medicare, Medicaid or CHIP
- Turning 26 and losing coverage through a parent’s plan
Changes in household
- Marriage or divorce
- Having or adopting a child
- Death of a member or eligible dependent
Changes in residence
- Seasonal work moving to or from the place they live and work
- Moving to/from a shelter or transitional housing
Other qualifying events
- Judgements, decrees or orders
- Open enrollment under the plan of another employer (spouse)
Important: Requests for an election change must occur within 30-days of, and be consistent with, the qualifying event.
If you believe that you have experienced a Qualifying Event that is not included on this list, please contact your Treasurer’s Office for further guidance.