Under certain circumstances, employees may be allowed to make changes to benefit elections during the plan year, if the event affects the employee, spouse, or dependent’s coverage eligibility. Any requested changes must be consistent with and on account of the qualifying event.

Examples Of Qualifying Events:

•Legal marital status (for example, marriage, divorce, legal separation, annulment);

•Number of eligible dependents (for example, birth, death, adoption, placement for adoption);

•Work schedule (for example, full-time, part-time);

•You, your spouse, or other covered dependent become enrolled in Part A, Part B, or Part D of Medicare

•Death of a spouse or child;

•Change in your child’s eligibility for benefits (reaching the age limit);

•Becoming eligible for Medicaid; or

•Your coverage or the coverage of your Spouse or other eligible dependent under a Medicaid plan or state Children’s Health Insurance Program (“CHIP”) is terminated as a result of loss of eligibility and you request coverage under this Plan no later than 60 days after the date the Medicaid or CHIP coverage terminates; or

•You, your spouse or other eligible dependent become eligible for a premium assistance subsidy in this Plan under a Medicaid plan or state CHIP (including any waiver or demonstration project) and you request coverage under this Plan no later than 60 days after the date you are determined to be eligible for such assistance.