Qualified Life Event | QLE

    QLE DEFINITIONS

    • All benefit elections made during initial enrollment or annual open enrollment remain in effect during the entire Plan Year; 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.
       

    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

    QLE & MID-YEAR CHANGES CHART WITH EFFECTIVE DATES

    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.
    • Note: You do not have to wait for a birth certificate. You may enroll your child with a crib card or hospital verification letter. 
    • Refer to How to Change Benefits for a Qualified Life Event (QLE) below.

     

    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

    WHEN YOU CAN CHANGE YOUR BENEFITS

    You may change your benefit elections under the following conditions:

    • Open Enrollment - annually in the fall
    • QLE - within the deadline 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 QLE.
      • If you have not experienced a QLE as defined above, you must wait until the next annual open enrollment period to make changes. 
    • Year-Round Benefit Changes
      • 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
      • Adjust Health Savings Account (HSA) contributions
      • Adjust Flexible Spending Account contributions - during COVID-19 National Emergency only

    HOW TO CHANGE BENEFITS FOR A 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 - 2021
    4. Deadline: Submit both forms WITH required documentation within 31 days of the QLE. 
    • Any missing information or supporting documents will delay processing, see below
    • Email: [email protected]
    • FAX: 602-542-4744

    SUPPORTING DOCUMENTATION REQUIREMENTS

    • Supporting documentation must be provided when adding/removing a spouse or dependent. 
    • See the QLE and Mid-Year Changes Chart for the documents required.
      • Note: You do not need a birth certificate to enroll a newborn. You may use a crib card or hospital verification letter. See "Newborn Coverage" above.
    • Deadline: All forms and required documentation must be submitted within 31 days, or loss of enrollment will result.