Qualifying Life Events

Qualifying Life Events

Making Enrollment Changes during the Year

Upon making benefit elections, they remain in effect until the next open enrollment period. The Annual Benefit plan year is January 1 through December 31.

IRS regulations allow changes to benefits outside of the open enrollment period in the event of a qualified life event. Qualified life events include:

Birth, Adoption
Marriage, Divorce
Death of spouse, domestic partner or other dependent
Spouse’s or domestic partner’s employment begins or ends
Dependent’s eligibility status changes due to age, student status, marital status or employment
Loss of other health coverage
Child Medical Support Orders

If you experience a qualified life event, you MUST notify Human Resources within 30 days of the event in order to make changes to your plan. Please contact CCM’s benefits team at [email protected]. Failure to make timely notice would require you to wait until the next open enrollment.

Qualifying Life Events and Documentation Requirements

Qualifying Life Event	Eligibility Requirements	Documentation to Submit
Marriage/Adding a Legal Spouse	Lawful spouse of the employee, unless legally separated. If you are divorced, your former spouse is ineligible for coverage.	ONE of the following documents: Marriage certificate – must be presently valid and issued by a State, County, or other applicable foreign government agency; or Copy of employee’s most recent filed federal income tax return Form 1040 – the first page only (social security numbers and financial information may be blacked out); or Letter or documentation showing last day of coverage. **Marriage certificates or copy of tax return is required when enrolling yourself and spouse during OE, as a new hire, or if you get married outside of these parameters you’ll have a QLE.
Formation/ Termination of Domestic Partnership	Domestic partnership notarized by legal entity.	Domestic Partnership Affidavit.
Loss of Coverage	Employee, Lawful Spouse, or Dependent Children.	Letter or documentation showing last day of coverage.
Death/Removing a Legal Spouse or Dependent	Lawful spouse of the employee or Legal Dependent.	Death certificate – must be presently valid and issued by a State, County, or other applicable foreign government agency.
Birth of child, Adoption of child, Obtaining Legal Guardianship of a Child or if Dependent Child under age 26 Loses Coverage elsewhere	UNDER age 26; and Child(ren) born to you; Stepchild(ren); Legally adopted child(ren) or child(ren) placed in your home for final adoption; Child(ren) under legal guardianship; Child(ren) covered under a Qualified Medical Child Support Order; Foster child(ren) that live with the employee.	ONE of the following documents: Birth certificate listing parents, or adoption paperwork; or Copy of employee’s most recent filed federal income tax return Form 1040 – the first page only (social security numbers and financial information may be blacked out); or Qualified Medical Child Support Order (QMCSO) which requires child support for benefit coverage; or Court paperwork for legal guardianship; or Letter or documentation showing last day of coverage. If you experience the birth or adoption of a new child, you are required to provide one of the above pieces of documentation. If your child (under age 26) loses coverage elsewhere, and you wish to add them to CCM plan, you are required to provide a letter or documentation showing last day covered.
Residence Change	Moving to a different zip code or county that changes your health plan area. (This is most likely for those that reside CA or HI and are on the Kaiser or HMSA plans—as the Anthem network is very broad across the US.)	New Rental Agreement; or Mortgage.
Medicare Enrollment	Employees age 65+ that are entitled to Medicare.	Proof of coverage from Medicare. (Note: if you voluntarily enroll in Medicare and choose to drop coverage with CCM, COBRA will not be offered to your dependent spouse or children.)