Qualifying Events

QUALIFYING EVENTS

If you are enrolled in the SEHP on a pretax basis, you may make mid-year changes to your coverage based on the following qualifying events:

• NEWLY ELIGIBLE DEPENDENTS

To add a newly eligible dependent to coverage, a Newly Eligible Dependent request must be submitted within 31 days of the event that makes the dependent(s) newly eligible. Members must submit the request along with supporting documentation in their SEHP Member Portal.

Click on the Mid Year Benefit Change Request tab, then select Newly Eligible Dependent, and fill in the information on the next page. The document upload button is located at the bottom of the Member & Family screen.

• MARRIAGE

You may add or drop your entire family as the entire family is now newly eligible. To add family members to your coverage, you will need to upload a copy of the marriage license along with the Add/Drop request in your Member Portal.

If you have been added to your Spouse’s group health plan coverage, submit a Member Waive Coverage (Midyear) request in your Member Portal and upload documentation showing you are covered under the spouse’s health plan with the effective date listed.

To add a new spouse and/or stepchild(ren) to coverage due to marriage, you will need to submit a Newly Eligible Dependent request in your SEHP Member portal. The enrollment request, along with the appropriate supporting documentation, must be uploaded within 31 days of the date of marriage.

The effective date of coverage will be the first day of the month following the date of marriage. If the marriage occurs on the first day of the month, the effective coverage date will be the first day of that month.

If you add a newly eligible spouse or stepchild(ren) to coverage, other eligible dependents, such as your other children, may also be added to coverage. The effective date of coverage for these dependents will be the first day of the month following the date of marriage. Your contributions will be due according to the effective date of dependent coverage.

• COMMON LAW MARRIAGE

Submit a Newly Eligible Dependent request in your Member Portal and upload a notarized copy of the completed Common Law Marriage Affidavit (under the Forms tab in your Member Portal) and proof of joint ownership. Acceptable documents for proof of joint ownership are listed below. Please block out any financial information before uploading. Documents submitted should have both you and your spouse listed.

• Current bank statement

• Current lease agreement

• Current homeowners’ insurance statement

• Current credit card statement

• Current property tax statement

• Current year federal filed tax return

• Current mortgage statement

• DIVORCE

In the event of divorce, you will need to submit a Remove Ineligible Dependent request and upload a copy of the divorce decree court document, including the Judge’s signature and the court date stamp. The ineligible spouse and stepchildren will be removed from your coverage on the last day of the month the divorce is final.

A divorce removes your ineligible ex-spouse and any stepchildren that may have been covered.

• NEWBORNS

Birth or adoption of a dependent – In the event of the addition of a dependent due to birth or adoption, you may add your entire family to your plan. You will need to submit a Newly Eligible Dependent request in your Member Portal and upload the birth certificate or a copy of the petition for adoption or placement, whichever is appropriate, for the newborn and a marriage certificate and birth certificate for any other children.

In this situation, you may only drop the entire family if the family members are now covered under another employer’s group plan.

To add a newborn to coverage, a Newly Eligible Dependent request must be submitted within 31 days of the birth. Members must submit the request in the SEHP Member Portal - https://sehp.member.hrissuite.com along with supporting documentation. After logging in, click on the Mid Year Benefit Change Request tab then select Newly Eligible Dependent and fill in the information on the next page.

A birth certificate, hospital announcement, and a valid SSN or ITIN (if applicable) must be uploaded to the member portal. To upload documents, use the Upload Documents button located at the bottom of the Member and Family screen.

• ADOPTIONS

For adoptions, a Newly Eligible Dependent request must be submitted within 31 days of the date that the petition for adoption or placement notice is filed or the date of adoption placement. A copy of the petition for adoption or placement notice, issued by the court including the Judge’s signature and court date stamp, must be uploaded in SEHP Member Portal with the request.

If the adoption is being handled through an adoption agency, they may require an adjustment period in the primary member’s home before filing the petition for adoption. In this case, a copy of the adoption agency’s placement letter must be uploaded in SEHP Member Portal with the Newly Eligible Dependent request and must indicate the date of placement as well as the length of the adjustment period.

When the adjustment period is over and the petition for adoption has been filed with the court, a copy of the petition for adoption issued by the court that includes the Judge’s signature and court date stamp must be uploaded in SEHP Member Portal to continue coverage for the dependent. If the dependent is removed from the primary member’s home, a Newly Eligible Dependent request must be submitted in SEHP Member Portal to remove the dependent from the primary member’s coverage.

If the dependent is being adopted from a foreign country and a petition for adoption has not been filed in a U.S. Court, the SEHP should be contacted for guidance.

If the date of the filing for a petition for adoption or placement in your home is within 31 days of the birth of the child, the coverage effective date is the date of birth, provided that a Newly Eligible Dependent request is submitted in SEHP Member Portal, and the appropriate documentation is uploaded within 31 days of the event. If the filing placement is not within 31 days of the date of birth of the child, the effective date of coverage is the date of the filing date of the petition for adoption or the date of placement, whichever the case may be. The effective date of coverage cannot be earlier than the child’s placement or arrival in your home within the United States.

NOTE: To add a newborn or newly adopted dependent to coverage, other eligible dependents may also be added to your coverage at this time. The effective date of coverage for the newborn or adopted dependent will be the date of birth. A Newly Eligible Dependent request and the appropriate documentation are required within 31 days of the child’s birth, date of placement for adoption, or date of petition for adoption.

• GRANDCHILDREN

A grandchild born to your covered dependent child may be covered under the SEHP, if a copy of the birth certificate, a completed Dependent Grandchild Affidavit, and appropriate proof of financial dependency and residency are uploaded in your SEHP Member Portal at the time of the Newly Eligible Dependent request within 31 days of the grandchild’s date of birth. You must claim your grandchild as a dependent on your Federal tax return, and at least one of the following conditions must be met:

• You have legal custody of or have lawfully adopted your grandchild.

• Your grandchild lives in your home and is the child of your dependent child covered under the SEHP and you provide more than 50% of the support of the grandchild or;

• Your grandchild is the child of your dependent child covered under the SEHP and is considered to reside with you even when your grandchild or your dependent child is temporarily absent due to special circumstances, including the education of your dependent child, and you provide more than 50% of the support for your grandchild.

NOTE: A Dependent Grandchild affidavit must be completed, notarized, and uploaded in in your SEHP Member Portal along with a copy of your grandchild’s birth certificate and a copy of the most recently filed Federal tax return showing that you claim your grandchild as a dependent, for proof of financial dependency and residency when submitting the Change Request in your SEHP Member Portal.

When you file the current year’s tax return, the return, with all financial information redacted and the grandchild claimed as a dependent, must be uploaded and a Communication Request stating that this has been done must be submitted in SEHP Member Portal by April 15th of the following year.

• NEW LEGAL CUSTODY/GUARDIANSHIP CHILDREN

(Dependents who are not biological, stepchildren or adopted children of the member)

To add a newly eligible legal custody/guardianship child to coverage, you need to submit a Newly Eligible Dependent request within 31 days of the date that the court issues a legal custody agreement. A copy of the court order or legal custody agreement and birth certificate must be uploaded to SEHP Member Portal with the request.

The effective date of coverage will be the first day of the month following the date of legal custody or guardianship. If the date of legal custody or guardianship occurs on the first day of a month, the effective coverage date will be that day.

For loss of legal custody of a dependent child, you will need to submit a Remove Ineligible Dependent request in your Member Portal and upload a copy of the court order including court recorded date stamp and judge’s signature to add or drop the dependent.

• CHANGE IN EMPLOYMENT

If you or your dependents have a change in employment, like moving from part time status to full time status or vice versa or moving to a position that affects benefits eligibility that will affect the cost, benefit level, or benefit coverage, you are eligible to change your health insurance coverage. Please contact your HR for assistance.

To enroll in coverage, you will submit a Communication Form in your Member portal stating that you are changing employment status or benefits eligibility and would like to enroll in coverage due to this change.

An enrollment portal will be opened, and an email will be sent to you explaining how to enroll.

If you would like to drop coverage, you will submit a Member Waive Coverage (Mid-Year) request in your Member Portal. Coverage will be dropped effective the last day in the eligible position. You will need to upload the proper documentation when you submit the request.

• TERMINATION OR COMMENCEMENT OF EMPLOYMENT (INCLUDING RETIREMENT):

Your HR department will submit the appropriate request in the HR portal, and the SEHP will process it, and a response will be sent to your HR department. You may change your medical plan at retirement if you continue Direct Bill.

For your spouse or a dependent loss or gaining of coverage, you will need to submit an Add/Drop request in your Member Portal and upload the appropriate documentation:

For spouse or dependent loss of other group health coverage, a letter or certificate of creditable coverage listing the member’s name and all dependents covered under a previous employer’s insurance. The letter or certificate must identify the previous employer and list the date coverage ended.

For spouses or dependents gaining other group health coverage, a certificate of creditable coverage from a new vendor/employer showing the plans, effective date, and who is covered is needed.

• DEATH

For the death of the employee, the employee’s HR department will submit a request in the HR portal and the death certificate, obituary or document approved by legal counsel will be uploaded. Surviving spouses/ dependents can continue coverage under either the COBRA or Direct Bill program.

If the death is the spouse or a dependent, you or your HR department will submit a Death of Spouse or Dependent request and upload the death certificate, obituary, or document approved by legal counsel.

• MILITARY INSURANCE CHANGES — You may make a mid-year change if you, your spouse, or your dependent are called to active military duty, and this results in a gain or loss of eligibility for military health insurance coverage. You will need to request a change in MAP and provide documentation of the gain or loss of the military coverage.

• Your dependent child turns 26 (coverage ends for your dependent on the last day of the month of their 26th birthday). The SEHP will notify you before your dependent’s birthday, and the change will be automatically applied to your benefits. If the change results in a different coverage tier, this change will be made by SEHP, and your contribution will be adjusted.

• Government sponsored VA benefits – If you, your spouse, or your dependent gain or lose government sponsored VA benefits, you may make a mid-year change in MAP. You will need to upload documentation of the change in VA benefits to accompany your enrollment request.

• Medicare eligibility – You may make a mid-year change if you, your spouse, or your dependent become newly eligible for Medicare and elect Medicare coverage as primary within 31 days of Medicare effective date.

Members or spouses turning 65 and becoming newly eligible for Medicare benefits will need to complete a TEFRA form to elect whether they want Medicare or SEHP coverage as primary. If Medicare is chosen as primary, medical coverage under the SEHP will end the last day of the month before the Medicare effective date. Notices are sent out approximately 60 days before the 65th birthday, including instructions on completing and uploading the TEFRA form.

If a member, spouse, or dependent loses Medicare eligibility, a communication form must be submitted in MAP, and documentation of the loss of Medicare benefits must be uploaded.

Entitlement to Medicaid – If you, your spouse, or dependent is entitled to coverage (i.e., becomes enrolled) title XIX of the Social Security Act (Medicaid) (Public Law 89-97 (79 Stat. 343)), while enrolled in the SEHP, you may make a mid-year change to cancel or reduce coverage of SEHP coverage. Contact your HR department to submit a request in the HR portal. Proof of coverage listing all covered individuals and the effective date of coverage.

In addition, if you, your spouse, or a dependent entitled to coverage under Medicaid loses eligibility for such coverage, you may make a mid-year change under SEHP. Contact your HR department to submit a request in the HR portal. Provide proof of loss of coverage, listing all covered individuals and the effective date of coverage termination.

• Dependent children losing eligibility/coverage under another group health insurance plan is a qualifying event for requesting a coverage change. An Add/Drop request must be submitted, and a letter or certificate of creditable coverage listing the name of the dependents covered and the effective date of termination must be uploaded in your Member Portal.

• For mid-year changes, the effective date of coverage or change in coverage will generally be the first day of the month following the event. For events that occur on the first day of a month, the effective coverage date will be the first day of the month. If a death occurs on the first day of a month, the change effective date will be the first day of the following month.

• For dependents gaining coverage under another group health plan, submit an Add/Drop request in your member portal and upload a letter or certificate from the employer or group health plan indicating the effective date of coverage and the names of the individuals that are covered under that plan will need to be uploaded.

• Dependent children identified under a Medical Withholding Order (K.S.A. 23-4,105) or Qualified Medical Child Support Order. If the SEHP receives a court order requesting a coverage change, the SEHP has the authority to add or remove dependent children without the employee’s consent. The SEHP will automatically change the member’s coverage to comply with the court’s order. Coverage and member contribution levels will be adjusted to reflect these changes.

• Dependent spouse or children who move to the U.S. is a qualifying event. Submit a COMMUNICATION FORM request in your Member Portal and upload copies of your marriage license, birth certificates, and the stamped Visa or air flight itinerary showing when the dependent entered the U.S. for the dependents being added.

• Children’s Health Insurance Program (CHIP) – Dependents losing CHIP coverage is a mid-year qualifying event and they can be added to SEHP coverage. Gaining CHIP coverage is not a qualifying event for removing dependents mid year.

• CHANGE IN EMPLOYEE CONTRIBUTION

The change in premium (if applicable) will be reflected on the next available paycheck after the SEHP receives and processes the request. The effective date will coincide with the date of birth, the date of petition for adoption, or the date of the placement agreement. If the date of birth, the date of the petition for adoption, or the date of the placement agreement occurs on the first day of the month, the change in your contribution will take place that day.

• AFTER TAX EVENTS

If you are enrolled in SEHP coverage on an after-tax basis, you may make mid-year additions and deletions from coverage due to the following events and subject to the requirements listed above.

All events are listed under Pretax Events.

Removing yourself and/or dependents from SEHP coverage for any reason (no documentation is required).

NOTE: Vision coverage may not be added during the Plan Year.  

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