Making Changes During the Year

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Generally, after you have made your benefit plan elections, you may change those elections only during the next annual open enrollment period.

However, if you experience a qualifying event or other allowable event during the year, you may change certain benefit plan elections before the next annual open enrollment period. You must properly advise Human Resources or the PCOC Benefits Service Center (along with providing the required supporting documentation) and make the change using the online benefits website within 31 days of the event in order for your mid-year change to be approved.

Your new election must be on account of the event and must correspond with that gain or loss of coverage. A qualifying event is defined as an event that results in the gain or loss of eligibility by you or your dependents. For example:

  • A change in legal marital status.
  • A change in number of dependents.
  • A change in employment status.
  • Your dependent satisfies or ceases to satisfy the requirements for dependents, including a domestic partner or domestic partner’s child.
  • A change in residence or worksite by you or your dependent that causes a loss or gain of coverage.

The rules regarding changes after your new hire enrollment and the annual open enrollment period are very specific; therefore, you should contact Human Resources or the PCOC Benefits Service Center if you require assistance.

Special Enrollment Rules

If you originally declined medical, dental and/or vision coverage because you had other health coverage, you may be eligible to change your elections under the following circumstances:

  • If the other coverage was COBRA and it is now exhausted; or
  • The other coverage was not COBRA and either the coverage terminated due to loss of eligibility or termination of employer contributions toward such coverage. Loss of eligibility includes legal separation, divorce, termination of domestic partner status, death or termination of employment.
  • The other coverage was Medicaid or state Child Health Insurance Program (CHIP) and coverage terminated due to loss of eligibility.
  • You or your dependent becomes eligible for state premium assistance under a Medicaid or CHIP plan. (This is an optional state program under Medicaid or CHIP that pays the employee’s share of the premium for group health plan coverage.)

If your dependents also had other health coverage and lost that coverage in the above situations, they may be added to your coverage. However, you will not be able to add yourself or your dependents to this coverage if the other coverage was terminated for cause (including failure to timely pay the required premiums).

In addition to the changes described above, you may enroll yourself and your spouse/domestic partner (with or without the new dependent) in a PCOC health care plan following marriage or the adoption, placement for adoption or birth of a child. You must be enrolled in order to cover your dependents.

Special Enrollment Procedure

You must enroll for coverage within 31 days of the special enrollment event (60 days for CHIP) by going online and making the appropriate change. Supporting documentation must be sent to Human Resources or the PCOC Benefits Service Center.

If you enroll and provide the required documentation within this period, the effective date of coverage will be the date of the special enrollment event. Your paycheck contributions will be deducted retroactive to the date of the special enrollment event.

If you do not enroll and provide supporting documentation within 31 days of the special enrollment event (60 days for CHIP), you may not enroll until the next annual open enrollment period.

For more information on how your benefits are affected by these life changes, contact the PCOC Benefits Service Center.

For example: If you and your spouse previously declined coverage, you may enroll yourself, your spouse and your newborn child immediately following the birth of the child, as long as you do so within 31 days of your baby’s birth. You may not enroll other children at this time unless another qualifying event makes them eligible for coverage, such as gaining legal custody of another eligible child.

Learn About Your Benefits

2023 Employee Beneifts Guide (Interactive)

2023 Employee Beneifts Guide (PDF)

Questions or need help?
Contact the PCOC Benefits Service Center

(855) 726-2291

pcocbenefits@teamcreativa.com