BFL CANADA’S ADMINISTRATION TIP OF THE MONTH | BY MATTHEW HANAK | NOVEMBER 1, 2018
When are you eligible to change your benefits coverage?
A life event within the scope of an employee benefit program, simply means a change in an employee’s personal situation that can make them eligible for a special enrolment period (i.e. within 31 days) to change their group health, dental and life benefits coverage.
This benefit change must be consistent with their change in family status. These changes include:
- Marriage, divorce or legal separation;
- Gain or loss of an eligible dependent for reasons such as birth, adoption, court order, disability, death, reaching the dependent age limit;
- Significant changes in employment or employer-sponsored benefit coverage that affect them or their spouse’s benefit eligibility;
- Loss of other insurance coverage;
- Dependent benefits are no longer offered by the Plan to a class of individuals that include them or their eligible dependent.
Should one of these life events apply to an employee, it is their responsibility to contact the Plan Administrator or Human Resources department within 31 days of the qualifying life event to request a change. The new benefit elections may start only after their change in status has taken place and the proper paperwork (stating the life event and the date this event will take effect) has been filed with the Insurer.
For example, an employee currently has single coverage and is engaged to be married. Given this life event, the employee will be eligible to change their benefits coverage from single to family, providing they do so within 31 days of the wedding date.
In another example, an employee may have declined Health and/or Dental coverage during initial enrolment as they have coverage through a spousal plan. Several months later, their spouse loses their coverage due to a change in employment. This life event would entitle the employee to add family coverage for Health and/or Dental benefits, as long as this change was made within 31 days of the life event.
Evidence of insurability may be required unless the change of coverage is applied for within 31 days of the life event.