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:

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.