Qualified Life Events | QLE
NEW - PROCESS QUALIFIED LIFE EVENTS ONLINE
The following events can be processed online: Birth, Adoption, Marriage, Divorce, and Legal Separation. See the "Qualified Life Event Processing" section below for more information.
INTRODUCTION
- All benefit elections made during your initial/new hire enrollment or annual open enrollment remain in effect during the entire Plan Year (January 1-December 31). However, there may be times when an employee may experience a change in their family or work status that may allow for certain benefits to be changed mid-year.
- These changes are called qualified life events (QLE) and are governed by the IRS regulations of Section 125 Cafeteria Plans and HIPAA Special Enrollment Rights.
- There are several changes you can make depending upon your event.
- To begin: Select your Qualified Life Event from the list below and follow the instructions.
GUIDES AND RULES
- Supporting Documentation List
- QLE and Mid-Year Changes Chart
- Duplicate/Dual Enrollment for State/University Employees
- Premiums - If premiums change, new amounts will be deducted beginning the pay period following the effective date of your coverage. No refunds of premiums for retroactive termination will be provided if notification of QLE is received beyond 31 days of the event.
QUALIFIED LIFE EVENT PROCESSING
BIRTH
| Changes During Benefits Enrollment - 31 Day Deadline from Date of Event | |||
| Activity | What You Can Do | How You Do It | When Coverage Begins |
| Medical, Dental, Vision | If you are enrolled in health insurance, you may add your newly eligible child to your current plans. | You have 31 days to add your child to your medical, dental and/or vision coverage on hrsystems.azdoa.gov> YES Portal> Bookmarks> Your Employee Services> Benefits> Life Events. In the Life Events Form Section, click "Birth." See the Birth Qualified Life Event User Guide for instructions. Supporting Documentation: Birth certificate. Note: You do not need to wait for a birth certificate, you may use a crib card or hospital letter, then submit the birth certificate after you obtain it. Your child’s Social Security number (SSN) is requested when you enroll your child. If you have not yet obtained an SSN, you may enroll your child without the number and submit it to HR-Benefits when you have it. | Coverage begins on the date of birth after all supporting documents are received. Please note that newborn children are covered under their mother’s insurance only for the first 31 days of their life. After that time, they must be enrolled, or they will not be covered. |
| Flexible Spending Account (FSA) | You may choose to enroll or change your contributions. | Medical FSA: Use pre-tax dollars to pay for qualified medical expenses. Learn more on the FSA page. Child/Adult Daycare FSA: Use pre-tax dollars to pay for qualified dependent care expenses. Learn more on the FSA page. Make changes during the benefits enrollment process shown above for "Medical, Dental, Vision." | Coverage begins on the date of birth after all supporting documents are received. |
| Short-Term Disability Insurance (STD) | You may choose to add short-term disability coverage. | The STD benefits from MetLife offer the ability to replace a portion of your earnings if you are sick or hurt and cannot work. Learn more on the Disability Insurance page. Make changes during the benefits enrollment process shown above for "Medical, Dental, Vision." | Coverage begins on the date of birth after all supporting documents are received. |
| Life Insurance | You may choose to purchase life insurance for your child. | The supplemental voluntary life insurance benefits from Securian offer the ability to purchase life insurance for all your dependents on one policy. Learn more on the Life Insurance page. Make changes during the benefits enrollment process shown above for "Medical, Dental, Vision." | Coverage begins on the date of birth after all supporting documents are received. |
| Changes to Make Anytime | |||
| Activity | What You Can Do | How You Do It | When Coverage Begins |
| Beneficiary Changes | You may choose to change or update beneficiaries for your retirement plan, life insurance, and/or deferred compensation programs. | Life Insurance: hrsystems.azdoa.gov> YES Portal> Bookmarks> Your Employee Services> Benefits> Beneficiary. Retirement Plan: Login to the Arizona State Retirement System (ASRS) and update your beneficiaries on the home page. Deferred Compensation: Complete the beneficiary forms for your 403(b) and 457 plans on the Nationwide AZ Smart Save site. | Changes can be made at any time and are effective immediately following the submission of the applicable change of beneficiary forms. |
| Tax Withholding | You may choose to review your federal and state tax withholdings and make any necessary adjustments. | To view your current withholding, visit hrsystems.azdoa.gov> YES portal> Bookmarks> Your Employee Services> Pay> Tax Withholding. To make changes, submit a new IRS W-4 and/or Arizona A-4 to your payroll office. | Tax withholding changes can be made at any time and are effective in the next available paycheck. |
| Educational Savings Plans | You may choose to consider participating in a Higher Education College Savings Plan. | Visit the AZ529.gov website for more information about participating in a 529 college savings plan. After you establish an account, you may set up direct deposits at hrsystems.azdoa.gov > YES portal> Bookmarks> Your Employee Services> Pay> Direct Deposit. | You can begin direct deposits from your paycheck at any time. |
| Additional Assistance | |||
| Child Care | You may need to secure child care for your child. | Please visit the Employee Assistance Program (EAP) for information regarding child care provider referrals. The EAP from CompPsych is available to all State employees and their families. Access these services by calling 1-877-327-2362 or visiting guidanceresources.com. Enter WEB ID: HN8876C to register. | Availability of child care facilities is maintained by individual facilities. |
| Employee Assistance Program | While adding a new child to your family is a happy event, you may benefit from assistance with making the adjustment. | Please visit the Employee Assistance Program (EAP) for information regarding free confidential counseling and referral services, including child care providers. The EAP from CompPsych is available to all State employees and their families. Access these services by calling 1-877-327-2362 or visiting guidanceresources.com. Enter WEB ID: HN8876C to register. | You may call or visit the website 24/7. |
ADOPTION
| Changes During Benefits Enrollment - 31 Day Deadline from Date of Event | |||
| Activity | What You Can Do | How You Do It | When Coverage Begins |
| Medical, Dental, Vision | If you are enrolled in health insurance, you may add your newly eligible child to your current plans. | You have 31 days to add your child to your medical, dental, and/or vision coverage on hrsystems.azdoa.gov> YES portal> Life Events. In the Life Events Form Section, click "Adoption." See the Adoption Qualified Life Event User Guide for instructions. Supporting Documentation: Birth certificate and adoption certificate. Note: For a newborn, you do not need to wait for a birth certificate, you may use a crib card or hospital letter. Your child’s Social Security number (SSN) is requested when you enroll your child. If you have not yet obtained an SSN for your child, you may enroll your child without the number and submit it to HR-Benefits when you have it. | Coverage begins on the date of adoption after all supporting documents are received. |
| Flexible Spending Account (FSA) | You may choose to enroll or change your contributions. | Medical FSA: Use pre-tax dollars to pay for qualified medical expenses. Child/Adult Daycare FSA: Use pre-tax dollars to pay for qualified dependent care expenses. Learn more on the FSA page.
| Coverage begins on the date of adoption after all supporting documents are received. |
| Short-Term Disability Insurance (STD) | You may choose to add short-term disability coverage. | The STD benefits from MetLife offer the ability to replace a portion of your earnings if you are sick or hurt and cannot work. Learn more on the Disability Insurance page. Make changes during the benefits enrollment process shown above for "Medical, Dental, Vision." | Coverage begins on the date of adoption after all supporting documents are received. |
| Life Insurance | You may choose to purchase life insurance for your child. | The supplemental voluntary life insurance benefits from Securian offer the ability to purchase life insurance for all your dependents on one policy. Learn more on the Life Insurance page. Make changes during the benefits enrollment process shown above for "Medical, Dental, Vision." | Coverage begins on the date of adoption after all supporting documents are received. |
| Changes to Make Anytime | |||
| Activity | What You Can Do | How You Do It | When Coverage Begins |
| Beneficiary Changes | You may choose to change or update beneficiaries for your retirement plan, life insurance, and/or deferred compensation programs. | Life Insurance: hrsystems.azdoa.gov> YES portal> Your Employee Servcies> Benefits> Beneficiary. Retirement Plan: Login to the Arizona State Retirement System (ASRS) and update your beneficiaries on the home page. Deferred Compensation: Complete the beneficiary forms for your 403(b) and 457 plans on the Nationwide AZ Smart Save site. | Changes can be made at any time and are effective immediately following the submission of the applicable change of beneficiary forms. |
| Tax Withholding | You may choose to review your federal and state tax withholdings and make any necessary adjustments. | To view your current withholding, visit hrsystems.azdoa.gov> YES portal> Bookmarks> Your Employee Services> Pay> Tax Withholding. To make changes, submit a new IRS W-4 and/or Arizona A-4 to your payroll office. | Tax withholding changes can be made at any time and are effective in the next available paycheck. |
| Educational Savings Plans | You may choose to consider participating in a Higher Education College Savings Plan. | Visit the AZ529.gov website for more information about participating in a 529 college savings plan. After you establish an account, you may set up direct deposits at hrsystems.azdoa.gov > YES portal> Bookmarks> Your Employee Services> Pay> Direct Deposit. | You can begin direct deposits from your paycheck at any time. |
| Additional Assistance | |||
| Child Care | You may need to secure child care for your child. | Please visit the Employee Assistance Program (EAP) for information regarding child care provider referrals. The EAP from CompPsych is available to all State employees and their families. Access these services by calling 1-877-327-2362 or visiting guidanceresources.com. Enter WEB ID: HN8876C to register. | Availability of child care facilities is maintained by individual facilities. |
| Employee Assistance Program | While adding a new child to your family is a happy event, you may benefit from assistance with making the adjustment. | Please visit the Employee Assistance Program (EAP) for information regarding child care provider referrals. The EAP from CompPsych is available to all State employees and their families. Access these services by calling 1-877-327-2362 or visiting guidanceresources.com. Enter WEB ID: HN8876C to register. | You may call or visit the website 24/7. |
MARRIAGE
| Changes During Benefits Enrollment - 31 Day Deadline from Date of Event | |||
| Activity | What You Can Do | How You Do It | When Coverage Begins |
| Medical, Dental, Vision | If you are enrolled in health insurance, you may add your spouse (and stepchildren, if applicable) to your current plans. If you are joining your spouse's plan, you may remove your coverage on the ADOA plan. | You have 31 days to add your spouse to your medical, dental and/or vision coverage on hrsystems.azdoa.gov> YES Portal> Bookmarks> Your Employee Services> Benefits> Life Events. In the Life Events Form section, click "Marriage." See the Marriage Qualified Life Event User Guide for full instructions. Supporting Documentation: For spouse, a marriage certificate. For stepchildren, a birth certificate and a marriage certificate. Name Change: Only update if you have legally changed it with the Social Security Administration (SSA). If you have not completed the SSA process, leave your name unchanged, but continue with your benefits changes now so you meet the 31-day deadline. After completing the SSA process, contact your HR office to have your name updated in YES. Your status and personal contact info are updated immediately in YES when you make the change. Your work email address will be updated when you submit your legal name change to your HR office. | Electing coverage: Coverage begins the first day of the next month following receipt of required documentation. Removing coverage: Termination of coverage is effective the last day of the pay the period in which the Member makes the last contribution. |
| Flexible Spending Account (FSA) | You may choose to enroll or change your contributions. | Medical FSA: Use pre-tax dollars to pay for qualified medical expenses. Learn more on the FSA page. Child/Adult Daycare FSA: Use pre-tax dollars to pay for qualified dependent care expenses. Learn more on the FSA page. Make changes during the benefits enrollment process shown above for "Medical, Dental, Vision." | Electing coverage: Coverage begins the first day of the next month following receipt of required documentation Removing coverage: Termination of coverage is effective the last day of the pay period which the Member makes the last contribution. |
| Short-Term Disability Insurance (STD) | You may choose to add short-term disability coverage. | The STD benefits from MetLife offer the ability to replace a portion of your earnings if you are sick or hurt and cannot work. Learn more on the Disability Insurance page. Make changes during the benefits enrollment process shown above for "Medical, Dental, Vision." | Coverage begins the first day of the next month following receipt of required documentation. |
| Life Insurance | You may choose to purchase life insurance for your child. | The supplemental voluntary life insurance benefits from Securian offer the ability to purchase life insurance for all your dependents on one policy. Learn more on the Life Insurance page. Make changes during the benefits enrollment process shown above for "Medical, Dental, Vision." | Electing coverage: Coverage begins the first day of the next month following receipt of required documentation. Removing coverage: Termination of coverage is effective the last day of the pay period which the Member makes the last contribution. |
| Changes to Make Anytime | |||
| Activity | What You Can Do | How You Do It | When Coverage Begins |
| Beneficiary Changes | You may choose to change or update beneficiaries for your retirement plan, life insurance, and/or deferred compensation programs. | Life Insurance: hrsystems.azdoa.gov> YES Portal> Bookmarks> Your Employee Services> Benefits> Beneficiary. Retirement Plan: Login to the Arizona State Retirement System (ASRS) and update your beneficiaries on the home page. Deferred Compensation: Complete the beneficiary forms for your 403(b) and 457 plans on the Nationwide AZ Smart Save site. | Changes can be made at any time and are effective immediately following the submission of the applicable change of beneficiary forms. |
| Tax Withholding | You may choose to review your federal and state tax withholdings and make any necessary adjustments. | To view your current withholding, visit hrsystems.azdoa.gov> YES Portal> Bookmarks> Your Employee Services> Pay> Tax Withholding. To make changes, submit a new IRS W-4 and/or Arizona A-4 to your payroll office. | Tax withholding changes can be made at any time and are effective in the next available paycheck. |
| Update Personal Information | You may need to change the contact information for you, your spouse, and your dependents. | To make changes, visit hrsystems.azdoa.gov > YES portal> Bookmarks> Your Employee Services> Personal Information. | Changes are effective immediately. |
| Direct Deposit | You may choose to change the account to which you are directly depositing your pay. | To make changes, visit hrsystems.azdoa.gov > YES portal> Bookmarks> Your Employee Services> Pay> Direct Deposit. | Changes are effective within two to three paychecks. |
| Educational Savings Plans | You may choose to participate in a Higher Education College Savings Plan for your stepchild. | Visit the AZ529.gov website for more information about participating in a 529 college savings plan. After you establish an account, you may set up direct deposits on hrsystems.azdoa.gov > YES portal> Bookmarks> Your Employee Services> Pay> Direct Deposit. | You can begin direct deposits from your paycheck at any time. |
| Additional Assistance | |||
| Child Care | You may need to secure child care for your stepchild. | Please visit the Employee Assistance Program (EAP) for information regarding child care provider referrals. The EAP from CompPsych is available to all State employees and their families. Access these services by calling 1-877-327-2362 or visiting guidanceresources.com. Enter WEB ID: HN8876C to register. | Availability of child care facilities is maintained by individual facilities. |
| Employee Assistance Program | While marriage is a happy event, you may benefit from assistance with making the adjustment. | Please visit the Employee Assistance Program for information regarding free confidential counseling and referral services, including child care providers. The EAP from CompPsych is available to all State employees and their families. Access these services by calling 1-877-327-2362 or visiting guidanceresources.com. Enter WEB ID: HN8876C to register. | You may call or visit the website 24/7. |
DIVORCE
| Changes During Benefits Enrollment - 31 Day Deadline from Date of Event | |||
| Activity | What You Can Do | How You Do It | When Coverage Begins |
| Medical, Dental, Vision | Your former spouse and your stepchildren are no longer eligible dependents for medical and dental coverage as of the first of the month following the divorce. They must be removed from the plan regardless of a court order to continue their coverage. Coverage must be obtained elsewhere. COBRA benefits are an option, and a packet will be sent to your ex-spouse upon disenrollment. (If you have adopted a stepchild, they may remain on the plan.) If you declined benefits and your divorce results in you losing coverage under your ex-spouse’s health insurance, see the Divorce, Legal Separation, and Annulment Process document. | You have 31 days following your divorce to remove your former spouse and stepchildren from coverage on hrsystems.azdoa.gov> YES portal> Bookmarks> Your Employee Services> Life Events. In the Life Events Forms section, click "Divorce." See the Divorce Qualified Life Event User Guide for instructions. Documentation: Divorce decree. Name Change: Only update if you have legally changed it with the Social Security Administration (SSA). If you have not completed the SSA process, leave your name unchanged, but continue with your benefits changes now so you meet the 31-day deadline. After completing the SSA process, contact your HR office to have your name updated in YES. Your status and personal contact info are updated immediately in YES when you make the change. Your work email address will be updated when you submit your legal name change to your HR office. | Termination of coverage is effective on the date of the divorce, after receiving supporting documentation. Premiums are not refunded. If premiums change, new amounts will be deducted beginning the pay period following receipt of documentation. |
| Flexible Spending Account (FSA) | You may choose to enroll or change your contributions. | Medical FSA: This account allows you to use pre-tax dollars to pay for qualified medical expenses. Child/Adult Daycare FSA: This account allows you to use pre-tax dollars to pay for qualified dependent care expenses. Learn more on the FSA page. Make changes during the benefits enrollment process shown above for "Medical, Dental, Vision." | Termination of coverage is effective on the date of the divorce, after receiving supporting documentation. Premiums are not refunded. If premiums change, new amounts will be deducted beginning the pay period following receipt of documentation. |
| Short-Term Disability | You may choose to add short-term disability coverage. | The STD benefits from MetLife offer the ability to replace a portion of your earnings if you are sick or hurt and cannot work. Learn more on the Disability Insurance page. Make changes during the benefits enrollment process shown above for "Medical, Dental, Vision." | Coverage is effective on the date of the divorce, after receiving supporting documentation. |
| Life Insurance | You may choose to remove Dependent Life insurance coverage for your former spouse and stepchildren. | Elect supplemental life insurance up to $20K or reduce supplemental life to a pre-tax amount of $35K. Elect dependent life insurance, any amount or decline dependent life if the spouse is the only eligible dependent. Learn more on the Life Insurance page. Make changes during the benefits enrollment process shown above for "Medical, Dental, Vision." | Termination of coverage is effective on the date of the divorce, after receiving supporting documentation. Premiums are not refunded. If premiums change, new amounts will be deducted beginning the pay period following receipt of documentation. |
| Changes to Make Anytime | |||
| Activity | What You Can Do | How You Do It | When Coverage Begins |
| Beneficiary Changes | You may choose to change or update beneficiaries for your life insurance, retirement plan, and/or deferred compensation programs. | Life Insurance: hrsystems.azdoa.gov> YES Portal> Bookmarks> Your Employee Services> Benefits> Beneficiary. Retirement Plan: Login to the Arizona State Retirement System (ASRS) and update your beneficiaries on the home page. Deferred Compensation: Complete the beneficiary forms for your 403(b) and 457 plans on the Nationwide AZ Smart Save site. | Changes are effective immediately following the submission of the applicable change of beneficiary forms. |
| Tax Withholding | You may choose to review your federal and state tax withholdings and make any necessary adjustments. | To view your current withholding, visit hrsystems.azdoa.gov> YES Portal> Bookmarks> Your Employee Services> Pay> Tax Withholding. To make changes, submit a new IRS W-4 and/or Arizona A-4 to your payroll office. | Tax withholding changes are effective in the next available paycheck. |
| Update Personal Information | You may need to change the contact information for you, your ex-spouse, and your dependents. | To make changes, visit hrsystems.azdoa.gov > YES portal> Bookmarks> Your Employee Services> Personal Information. | Changes are effective immediately. |
| Direct Deposit | You may choose to change the account to which you are directly depositing your pay. | To make changes, visit hrsystems.azdoa.gov > YES portal> Bookmarks> Your Employee Services> Pay> Direct Deposit. | Changes are effective within two to three paychecks. |
| Additional Assistance | |||
| Employee Assistance Program | If a change in marital status is causing you stress on or off the job, you may benefit from assistance with making the adjustment. | Please visit the Employee Assistance Program for information regarding free confidential counseling and referral services, including child care providers. The EAP from CompPsych is available to all State employees and their families. Access these services by calling 1-877-327-2362 or visiting guidanceresources.com. Enter WEB ID: HN8876C to register. | You may call or visit the website 24/7. |
LEGAL SEPARATION
| Changes During Benefits Enrollment - 31 Day Deadline from Date of Event | |||
| Activity | What You Can Do | How You Do It | When Coverage is Available |
| Medical, Dental, Vision | Your spouse is eligible to continue participating in the plans because you are still married. If the notice of legal separation requires healthcare coverage to continue for your spouse, you cannot remove coverage until the divorce is finalized. If the notice of legal separation does not require healthcare coverage to continue for your spouse, then you may choose to remove your spouse from coverage before the divorce is finalized. | You have 31 days to add your spouse to your medical, dental and/or vision coverage on hrsystems.azdoa.gov> YES Portal> Bookmarks> Your Employee Services> Benefits> Life Events. In the Life Events Form section, click "Legal Separation." See the Legal Separation Life Event User Guide for full instructions. Documentation: Legal separation decree. Name Change: Only update if you have legally changed it with the Social Security Administration (SSA). If you have not completed the SSA process, leave your name unchanged, but continue with your benefits changes now so you meet the 31-day deadline. After completing the SSA process, contact your HR office to have your name updated in YES. Your status and personal contact info are updated immediately in YES when you make the change. Your work email address will be updated when you submit your legal name change to your HR office. | Coverage ends at the end of the pay period following the date of legal separation after all supporting documentation is submitted. |
| Flexible Spending Account (FSA) | You may choose to enroll or change your contributions. | Medical FSA: This account allows you to use pre-tax dollars to pay for qualified medical expenses. Child/Adult Daycare FSA: This account allows you to use pre-tax dollars to pay for qualified dependent care expenses. Learn more on the FSA page. Make changes during the benefits enrollment process shown above for "Medical, Dental, Vision." | Termination of coverage is effective on the date of the legal separation, after supporting documentation is received. Premiums are not refunded. If premiums change, new amounts will be deducted beginning the pay period following receipt of documentation. |
| Short-Term Disability | You may choose to add or remove coverage. | The STD benefits from MetLife offer the ability to replace a portion of your earnings if you are sick or hurt and cannot work. Learn more on the Disability Insurance page. Make changes during the benefits enrollment process shown above for "Medical, Dental, Vision." | Coverage is effective on the date of the legal separation, after supporting documentation is received. |
| Life Insurance | You may choose to remove Dependent Life insurance coverage for your former spouse and stepchildren. | Elect supplemental life insurance up to $20K or reduce supplemental life to a pre-tax amount of $35K. Elect dependent life insurance, any amount or decline dependent life if the spouse is the only eligible dependent. Learn more on the Life Insurance page. Make changes during the benefits enrollment process shown above for "Medical, Dental, Vision." | Termination of coverage is effective on the date of the legal separation, after receiving supporting documentation. Premiums are not refunded. If premiums change, new amounts will be deducted beginning the pay period following receipt of documentation. |
| Changes to Make Anytime | |||
| Activity | What You Can Do | How You Do It | When Coverage Begins |
| Beneficiary Changes | You may choose to change or update beneficiaries for your retirement plan, life insurance, and/or deferred compensation programs. | Life Insurance: hrsystems.azdoa.gov> YES Portal> Bookmarks> Your Employee Services> Benefits> Beneficiary. Retirement Plan: Login to the Arizona State Retirement System (ASRS) and update your beneficiaries on the home page. Deferred Compensation: Complete the beneficiary forms for your 403(b) and 457 plans on the Nationwide AZ Smart Save site. | Changes are effective immediately following the submission of the applicable change of beneficiary forms. |
| Tax Withholding | You may choose to review your federal and state tax withholdings and make any necessary adjustments. | To view your current withholding, visit hrsystems.azdoa.gov> YES Portal> Bookmarks> Your Employee Services> Pay> Tax Withholding. To make changes, submit a new IRS W-4 and/or Arizona A-4 to your payroll office. | Tax withholding changes are effective in the next available paycheck. |
| Update Personal Information | You may need to change the contact information for you, your former spouse, and your step-children. | To make changes, visit hrsystems.azdoa.gov > YES portal> Bookmarks> Your Employee Services> Personal Information. | Changes are effective immediately. |
| Direct Deposit | You may choose to change the account to which you are directly depositing your pay. | To make changes, visit hrsystems.azdoa.gov > YES portal> Bookmarks> Your Employee Services> Pay> Direct Deposit. | Changes are effective within 2 to 3 paychecks. |
| Additional Assistance | |||
| Employee Assistance Program | If a change in marital status is causing you stress on or off the job, you may benefit from assistance with making the adjustment. | Please visit the Employee Assistance Program for information regarding free confidential counseling and referral services, including child care providers. The EAP from CompPsych is available to all State employees and their families. Access these services by calling 1-877-327-2362 or visiting guidanceresources.com. Enter WEB ID: HN8876C to register. | You may call or visit the website 24/7. |
AGE 26 DEPENDENT TERMINATION PROCESS
Please refer to the Age 26 Dependent Termination Process document for full details.
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TERMINATION OF EMPLOYER BENEFITS - OPTIONS TO CONTINUE COVERAGE
If your employer 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 your dependents may extend coverage per 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, Securian | 833-745-5517 | lifebenefits.com/plandesign/Arizona| Determine your life insurance needs: Benefits Scout
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DEATH
For the death of a State employee
- Please refer to the State Employee Information Organizer with important information in the event of death while employed with the State. Benefits are outlined on p. 7.
- For more information, please contact a Benefit Options representative by phone 602-542-5008, toll-free 1-800-304-3687, by email at [email protected].
Death of a spouse or dependent
Please submit the following forms to [email protected]
- Declaration For Change Form
- Active Benefits Enrollment Form
- Death certificate
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CHANGE IN PLACE OF RESIDENCE
If enrolled in DHMO dental plan, you may change to PPO dental plan if moving out of the coverage area. NOTE: Not applicable to medical and vision coverage since plans are nationwide unless the situation involves moving in or out of the country. To see changes you can make, please refer to the QLE and Mid-Year Changes Chart - p. 9.
Please submit the following forms to [email protected]
LOSS OF ELIGIBILITY FOR MEDICAID OR CHIP COVERAGE
Changes must be made within 60 days. Coverage begins the first day of the next month following receipt of documentation. To see changes you can make, please refer to the QLE and Mid-Year Changes Chart - p. 11.
Please submit the following forms to [email protected]
CHANGE IN EMPLOYEE, SPOUSE OR DEPENDENT EMPLOYMENT STATUS OR WORK HOURS
Changes 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.
To see changes you can make, please refer to pg. 6-7 and pg. 10 of the QLE and Mid-Year Changes Chart
Please submit the following forms to [email protected]
ADDITIONAL LIFE EVENTS NOT LISTED
Please refer to the QLE and Mid-Year Changes Chart for your event.
For more information, please contact a Benefit Options representative by phone 602-542-5008, toll-free 1-800-304-3687, by email [email protected].
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