Qualifying Events
The IRS regulations for mid-year health insurance changes (those outside of the annual open enrollment period each October) restrict any changes to your plan or coverage unless you have a qualified "change in status."
Any changes you make must be consistent with a change in status and made within 31 days of the date the event (marriage, birth, etc.) occurs.
Qualified Changes in Status (Defined by the IRS)
- Change in legal marital status, including marriage, divorce, legal separation, annulment, and death of a spouse
- Change in number of dependents, including birth, adoption, placement for adoption, or death of a dependent child
- Change in employment status, including the start or termination of employment by you, your spouse, or your dependent child
- Change in work schedule, including an increase or decrease in hours of employment by you, your spouse, or your dependent child, including a switch between part-time and full-time employment that affects eligibility for benefits
- Change in a child's dependent status, either newly satisfying the requirements for dependent child status or ceasing to satisfy them
- Change in place of residence or worksite, including a change that affects the accessibility of network providers
- Change in your health coverage or your spouse's coverage attributable to your spouse's employment
- Change in an individual's eligibility for Medicare or Medicaid
- A court order resulting from a divorce, legal separation, annulment, or change in legal custody (including a Qualified Medical Child Support Order) requiring coverage for your child or dependent foster child
- An event that is a special enrollment event under HIPAA (the Health Insurance Portability and Accountability Act), including acquisition of a new dependent or spouse or loss of coverage under another health insurance policy or plan if the coverage is terminated because of:
- Voluntary or involuntary termination of employment or reduction in hours of employment or death, divorce, or legal separation,
- Termination of employer contributions toward the other coverage, OR
- If the other coverage was COBRA Continuation Coverage, exhaustion of the coverage
Required Documentation When Adding a Spouse or Child
For the qualifying events of adding a spouse or dependent to your health, dental, or vision insurance plans, you must also submit required dependent documentation by fax (513-529-4223) or email to the Benefits office within 31 days of qualifying event. Social Security Numbers (SSN) are required for all dependents. Call the Benefits office at 513-529-3926 with SSNs. Do NOT send social security numbers through email.
Adding a Spouse
When completing the online Insurance Coverage Change Form, you must also submit a copy of your marriage certificate for health, dental, and vision coverage.
If you are covering your spouse on your Miami health insurance, you must also submit the following:
- Spouse Health Coverage form
- Employer Certification form (PDF 67KB), depending on your answers to questions on the spouse health coverage form.
- Social Security number and birth date are also required for all coverage.
Adding a Dependent Child
When completing the online Insurance Coverage Change Form, you must also submit the following documentation depending on the reason you are adding a child to your plan:
- When adding a newborn, submit a copy of birth certificate.
- When adding a child because they lost other coverage, submit a copy of birth certificate or court-approved papers, and documentation showing loss of previous coverage.
- If you're adopting, submit a copy of your court-approved adoption papers or copy of your placement letter from the court/adoption agency.
- For adding a legal custody or guardianship, submit a copy of your court-approved papers.
- Social Security number and birth date are also required for all coverage.
NOTE: Your spouse can be covered under Miami's health plan if:
- unemployed
- self-employed and does not provide health insurance for anyone they employ
- self-employed and provides coverage, but pays more than 50% of the total premium
- retired and the only source of health coverage is Medicare
- eligible for retiree coverage, but required to pay more than 50% of the total premium
- employed, but not eligible for their employer’s coverage or
- employed, but required to pay more than 50% of the total premium.
Spouses may be covered under your dental and vision plans regardless of employment or retirement status.