Qualified Life Event | QLE

WHEN YOU CAN CHANGE YOUR BENEFITS

You may change your benefit elections under the following conditions:

  1. Open Enrollment - annually in the fall
  2. Qualified Life Event (QLE) - within the specified time period listed below
  • The changes you can make are dependent on the type of QLE. See the QLE and Mid-Year Changes Chart for full details.
  • Deadline: All forms and required documentation must be submitted within 31 days of the QLE, as outlined below under How to Change Benefits for a Qualified Life Event (QLE).
  • If you have not experienced a QLE as defined below, you must wait until the next annual open enrollment period to make changes. 


Exceptions: Year-Round Benefit Changes

Changes that are allowed at any time throughout the plan year:

  • Decline Short-Term Disability coverage
  • Decrease Supplemental Life in increments of $5,000 to pre-tax amount of $35K, if applicable
  • Decline Dependent life
  • Life insurance beneficiary changes
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HOW TO CHANGE BENEFITS FOR A QUALIFIED LIFE EVENT (QLE)

  1. Gather: All required documentation as listed on the QLE and Mid-Year Changes Chart
  2. Fill out: Declaration for Change Form 
  3. Fill out: Active Benefits Enrollment Form-2020 
  4. Deadline: Submit both forms WITH required documentation within 31 days of the QLE. 
  • Any missing information or supporting documents will delay processing.
  • Email: [email protected]
  • FAX: 602-542-4744
     

NEWBORN COVERAGE - 31 DAY DEADLINE


Your newborn is ONLY covered under your insurance for the first 31 days after birth.

Before the 31st day, you must ENROLL your newborn as a dependent.

Deadline: If you miss the 31-day requirement, your newborn will not have coverage. You will have to wait to enroll until the next Open Enrollment or Qualified Life Event.

To enroll your child, submit a declaration for Change form with a birth certificate, crib card or hospital verification letter. You do not have to wait for the birth certificate.

Refer to How to Change Benefits for a Qualified Life Event (QLE) as seen above.
 

QUALIFIED LIFE EVENT (QLE) DEFINITIONS

Qualified Life Events (QLEs) include but are not limited to the following:

  • Marital status: marriage, divorce, legal separation, annulment, death of a spouse
  • Dependent status: birth, adoption, placement for adoption, death, marriage or dependent eligibility due to age
  • Eligibility status: becoming eligible for Medicare
  • Residence status: resulting in different plan options available 
  • Employment status or work schedule: affecting benefit eligibility for you, your spouse, and/or dependent. 
    Can include:
    • LWOP - leave without pay 
    • Returning from an Approved Leave: If coverage was modified at the initiation of leave, you must elect your previous level of medical, dental and/or vision coverage. 
      Premiums must be current or you may not re-elect any coverage until the next open enrollment period.
    • Return to Work Retirees - see the information listed below.
  • Additional QLEs - for a full list see the QLE & Mid-Year Changes Chart

SUPPORTING DOCUMENTATION REQUIREMENTS

  • Supporting documentation must be provided when adding/removing a spouse or dependent.
  • Deadline: All forms and required documentation must be submitted within 31 days, or loss of enrollment will result. 
  • See the QLE and Mid-Year Changes Chart for the documents required.

DUPLICATE/DUAL ENROLLMENT - BOTH SPOUSES STATE EMPLOYEES

Duplicate/dual enrollment in State plans is prohibited and will be terminated with no refunds for the premiums paid. For spouses who are State and/or a State University employees and/or retirees, these rules apply:

  • You cannot enroll each other as dependents, nor have your children enrolled twice.
  • One spouse may elect coverage for the entire family, or each spouse may elect their own individual coverage.
  • Dependent children can be on one spouse's policy or divided between spouses.
  • If your child is a State and/or State University employee, he/she cannot be enrolled as a single subscriber in a State plan and as a dependent on your policy. 
  • You cannot enroll simultaneously as a single subscriber in the retiree medical, dental, and/or vision plans for the Arizona Department of Administration (ADOA) AND the Arizona State Retirement System (ASRS).

 

TERMINATION OF COVERAGE - CONTINUATION OF BENEFITS

If your benefits are terminated, you may have options to continue coverage:

  • Medical/Dental/Vision 
    • If you experience a loss of coverage due to termination of employment or a QLE, you and or your dependents may extend coverage in accordance with COBRA (Consolidated Omnibus Budget Reconciliation Act). 
    • The Benefits Services Division will determine eligibility.
    • Learn more on our COBRA page. 
  • Life Insurance
    • You and/or your dependents may have the option to convert your life insurance coverage.
    • Contact our carrier, The Hartford at 866-712-3443.
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FORMS

To add or remove coverage, you must submit both of the forms listed below:

  1. Declaration for Change Form
  2. Active Benefits Enrollment Form - 2020
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