Life Events

You may make changes to your benefit election during the Plan Year if you experience a Mid-Year Qualifying Event. These include:

  • Marriage, Divorce, or Annulment;

  • Birth or adoption/placement for adoption;

  • Employment status of Employee, dependent, or spouse which affects eligibility to participate in the employer’s health plan;

  • Commencement of or returning from an unpaid leave of absence;

  • Dependent satisfies or ceases to satisfy eligibility requirements;

  • Judgment, decree or order changing legal custody;

  • Cost and/or coverage changes in employee’s, dependent’s or spouse’s health plan;

  • Enrollment in an insurance plan through the Health Insurance Marketplace, also known as the health insurance “exchange”;

  • Entitlement to or loss of eligibility for Government-sponsored programs; or

  • Death of spouse or dependent.

To Make a Mid-Year Election

To make a change in your coverage that relates to a Mid-Year Qualifying Event, as determined by the Plan and IRS Section 125 Regulations, you must submit a Health Plan change application and documentation of the Mid-Year Qualifying Event. Examples of official documents include: marriage or death certificates, obituaries, birth certificates, hospital- provided proof of birth letters, divorce decrees and adoption agreements signed by a judge, official letters from employers stating dates employment begins or ends as appropriate, and legal custody orders.

Any coverage changes you make must be consistent with the Mid-Year Qualifying Event. For example, if you get married, you may change your Employee Only coverage level to Employee Plus Spouse or Family, but you may not switch your coverage to the Choice Health from Value Health.

Coverage changes will be effective the first of the month following receipt of the application at the University Human Resources Benefits Division, except births and adoptions. Those changes for the newborn or newly adopted child are effective on the date of birth or adoption if an enrollment application is received within 60 days of the birth or adoption. The addition of other dependents to your policy is effective the first of the month after the date of birth or adoption if an enrollment application is received within 60 days of the birth of adoption. If you submit an application more than 60 days after the date of birth or adoption, but within the same plan year, the coverage will be effective the first of the month following receipt of the application. Enrollment changes being submitted due to ineligibility are also effective the first of the month following the Qualifying Event. Premium changes due to ineligibility are effective the first of the month following receipt of the form if the form is received MORE THAN 60 DAYS AFTER THE QUALIFIYING EVENT but within the same Plan Year as the Qualifying Event. Applications for changes in membership must be accompanied by documentation and received in the UniversityHuman Resources Benefits Division within 60 days of the qualifying event or within the same plan year as the mid-year qualifying event and are effective the first of the month following receipt of the form or that day if the form is received on the first of the month unless they are terminating due to ineligibility. Supporting documentation for Medical Center employees requesting changes with a UVa Health Plan application due to mid-year qualifying events must be submitted to the UHR Benefits Division within 7 calendar days of the application being submitted. Supporting documentation for Academic employees requesting changes in Benefits@ due to mid-year qualifying events must be faxed to the UVA Benefits Division at 434-924-4486 within 7 calendar days of the request being entered in Benefits@.

Special Enrollment Rights

There are certain Mid-Year Qualifying Events that provide you with Special Enrollment Rights:

  • For birth, adoption, or placement for adoption, you can enroll yourself, the new child, as well as any other eligible dependents not already on your policy. If you make application to add the child within 60 days of the event, the coverage is retroactive to the first of the month of the event date. The addition of other dependents to your policy will be retroactive to the first of the month after the event date.

  • For marriage, you can enroll yourself, your new spouse, and any other eligible dependents not already on your policy. The coverage is effective the first of the month following receipt of the enrollment application at the University Human Resources Benefits Division or online request.

  • An additional Special Enrollment Right is granted by a federal law known as HIPAA when eligibility is lost for other coverage or when COBRA coverage is exhausted or terminated. Based on these events, you may enroll yourself, your spouse, and/or your dependents who have lost other coverage within 60 days of the event. The coverage is effective the first of the month following receipt of the enrollment application at the University Human Resources Benefits Division.