When you enroll in benefits, your elections remain in effect to the end of the calendar year and you cannot make any changes until the next Open Enrollment period, which is usually in October. However, if you experience a qualified family status change during the calendar year, you may be able to make a benefit change that corresponds with the status change.
Facing a change?
You may also want to look into the Work/Life Resource Center and Faculty and Staff Assistance Program (FASAP) services the university offers you.
Work/Life can provide information about child care (referrals for child care and emergency needs), elder care and flexible scheduling.
To change your coverage(s) when a qualified family status change occurs, you must act within 30 days of the qualifying event for the expected change to be accepted by the university. Otherwise, you will have to wait for the next Open Enrollment period in which you are eligible to participate and have the change(s) become effective the following January 1. It is especially important to delete any ineligible dependents from your coverage within the 30-day time frame to avoid overpaying premiums that would not be refunded. For more information on how changes to your coverage affect your benefit costs, see Paying for Your Benefits.
Changing Your Coverage
You may change your coverage if you experience a qualified family status change and the benefit change you request corresponds with a gain or loss of eligibility for coverage. For example, a marriage is a family status change that would allow you to change from one-person health plan coverage to two-person coverage because acquiring a new dependent is consistent with a gain in eligibility for health plan coverage. Click the links at the top of the page for information specific to particular life events, such as birth, adoption, or divorce.
Qualified family status changes are defined
by Section 125 of the Internal Revenue Code, based on individual
circumstances and plan eligibility. This list of events
may not apply to every benefit plan.
To change your benefits coverage when a qualified family status change occurs, you must act within 30 days of the qualifying event.
- Legal marital status. Marriage, death of spouse, divorce, or annulment.
- Number of dependents. Birth, adoption, placement for adoption or death of a dependent.
- Employment status. Termination or commencement of employment by the employee, spouse, or dependent that results in a change for benefits eligibility.
- Work schedule. Switch between part-time and full-time work, a strike or lockout, commencement of or return from an unpaid leave of absence, or an increase or decrease in hours of employment by the employee, spouse or dependent that results in a change for benefits eligibility.
- Dependent status. Either satisfying or ceasing to satisfy the age or other requirements to qualify as a covered dependent under the plan. Examples: Your OQA newly satisfies the six-month residency eligibility requirement for OQAs; you and your spouse divorce.
- Resident or work site. Change in faculty or staff member's, spouse's, or dependent's residence or work site that result in loss of coverage. Examples: You are enrolled in an HMO and move to a county outside of your plan's service area; your spouse is enrolled in his/her employer's plan and that employer decides to offer all employees only one plan option that does not include your geographic location within the plan's service area.
- Domestic relations orders. A court order resulting from a divorce, legal separation, annulment, or change in legal custody that requires health plan coverage for the employee's child under the employee's health plan, or can end contributions for the child if the order requests the employee's former spouse to provide the coverage.
- Medicare and Medicaid. A corresponding change is permitted under the Children's Health Insurance Program Reauthorization Act of 2009 (CHIPRA) due to the faculty or staff member's, spouse's, or dependent's gain or loss of Medicare or Medicaid eligibility. Changes under this rule must be reported within sixty (60) days after gaining or losing coverage in Medicaid or the state CHIP program. Your change will be effective as of the event date.
Your Spouse's or Other Qualified Adult's Open Enrollment
Faculty and staff who have the opportunity to enroll on their spouse’s or OQA’s group health plan may remove their dependent(s) or cancel their U-M health plan coverage at any time during the year. Canceling the U-M health plan also cancels prescription drug coverage. In order to drop dependents or cancel your U-M coverage, faculty and staff must notify SSC Benefits Transactions within 30 days after the new coverage takes effect by completing and submitting a Benefits Enrollment/Change Form (PDF).
Effective Date of Coverage Changes
If you submit a change to add a dependent or enroll in coverage within 30 days of the event, changes are effective as of the event date. If you are requesting to remove an ineligible dependent or cancel coverage, changes are effective the first of the following month. If you don’t report the change in your coverage(s) within 30 days of the change in status event, you must wait until the next Open Enrollment Period to make a change to your coverage(s) and the change will be effective on January 1. Any changes in your deduction amount due to a change in benefits enrollments resulting from a status change will be reflected in your paycheck. If changes to your U-M benefits occur during the month, cost adjustments are made the following month. For example, if you add a dependent to your coverage on the second day of the month or later, your benefit cost increase takes effect the following month. Likewise, if you remove a dependent from your coverage on the second day of the month or later, the cost decrease takes effect the following month.
Special Enrollment Under HIPAA
Under the Health Insurance Portability and Accountability Act of 1996 (HIPAA), a special enrollment period for health coverage may be available if you lose coverage under certain conditions or when you acquire new dependents by marriage, birth, or adoption.
If you are declining enrollment for yourself or your dependents (including your spouse) because of other health coverage, you may in the future be able to enroll yourself or your dependents in U-M health coverage, provided that you request enrollment by completing the Group Health Insurance Application for Special Enrollment form (PDF) and sending the form to SSC Benefits Transactions within 30 days after your other coverage ends. In addition, if you have a new dependent as a result of marriage, birth, adoption, or placement for adoption, you may be able to enroll yourself and your dependents, provided that you request enrollment within 30 days after the marriage, birth, adoption, or placement for adoption.
Questions about Mid-Year Changes?
Call the SSC HR Contact Center at 5-2000 from the Ann Arbor campus, 734-615-2000 locally, or 866-647-7657 toll free, Monday through Friday from 8 a.m. to 5 p.m. Or you may view answers to frequently asked benefits questions or ask a question by visiting Ask HR at askhr.umich.edu.
The University of Michigan in its sole discretion may modify, amend, or terminate the benefits provided with respect to any individual receiving benefits, including active employees, retirees, and their dependents. Although the university has elected to provide these benefits this year, no individual has a vested right to any of the benefits provided. Nothing in these materials gives any individual the right to continued benefits beyond the time the university modifies, amends, or terminates the benefit. Anyone seeking or accepting any of the benefits provided will be deemed to have accepted the terms of the benefits programs and the university's right to modify, amend or terminate them.