Making health plan changes outside of open enrollment
Open enrollment is the only time each year when faculty and staff can make changes to their health plans and covered family members for any reason or no reason at all. During the rest of the year, changes can only be made if the participant experiences a “qualifying mid-year event” that allows changes. For the rest of this entry, we will refer to qualifying mid-year events as QMEs.
There are several different types of QMEs, and each type allows certain changes. QMEs generally consist of changes to family status (marriage, divorce, childbirth, adoption), coverage eligibility under a health plan (such as becoming eligible for, or losing eligibility for, another health plan outside of VCU) or job status changes (such as beginning or ending an unpaid leave, or switching between full-time and part-time employment when that switch affects a participant’s eligibility for VCU’s premium contribution).
For a full list of QMEs and a fact sheet for each, click here.
Changes due to QMEs must be requested within 60 calendar days of the event. The change to health coverage becomes effective on the first of the month after the request is received, or the first of the month after the QME occurs, whichever is later. The only exceptions that allow retroactive changes are childbirth, adoption, or a covered family member’s loss of eligibility (due to divorce, for instance). These changes are effective retroactively as long as they are requested within 60 days of the QME.
Changes may be requested using a paper enrollment form or online via Employee Direct. When a participant adds any covered family member(s) to the health plan, dependent eligibility documents are required along with the enrollment request. Paper enrollment forms (if used) and dependent eligibility documents must be received by VCU Benefits within 60 days of the QME.