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Mar 5 2019

Making plan changes with a Qualifying Status Change (QSC) Event

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Department of Management Services

Making plan changes with a Qualifying Status Change (QSC) Event

If you have a Qualifying Status Change (QSC) event that results in a gain or loss of eligibility for coverage, you have 60 days (unless otherwise noted) from the date of the event to make changes to your benefits. Changes include enrolling or cancelling, increasing or decreasing coverage, or adding or removing dependents. See the QSC Matrix ( 275.23 KB ) for the complete list of QSC events and documentation requirements.

If you have a QSC event and want to change your benefit elections:

Make the change online at People First within 60 days of the event (unless otherwise noted). If your specific QSC event is not listed or you do not have supporting documentation, call the People First Service Center within the same time frame, otherwise you will have missed your election window and will be unable to make any changes.

Birth, adoption, divorce, death, Medicare disability and court orders require documentation before your QSC event can be processed. If you experience one of these events, send your documentation to People First within 60 days of the event; then call People First to make changes to your insurance. If you miss your window, you may pay more for insurance than you need to or be responsible for claims incurred (for ineligible dependents, for example).

If you enroll yourself or your eligible dependents during the year because of a QSC event, coverage begins on the first day of the month after the month in which the state deducts (or People First receives) a full month’s premium. Coverage always begins on the first day of a month and, if you are a salaried employee, continues for the rest of the calendar year, as long as you pay premiums on time and you and your dependents remain eligible. If you are an OPS/variable-hour employee, your health insurance coverage is guaranteed for 12 months, as long as you remain employed by the state. Other plans will end at the same time as your health insurance if you no longer meet the eligibility requirements.

Active employees: If you go off the payroll, and do not cancel your coverage you must pay your share of the premium by personal check, cashier’s check or money order to continue coverage. You may be required to pay the full premium cost—your share and the state’s share, depending on the reason you are not working. Call People First Service Center for more information.

If you do not want to continue your insurance coverage while you are off the payroll, call People First within 60 days of your leave date to cancel. This ensures you can enroll in coverage if you return to work. If you do not cancel and are later cancelled because you did not pay your premiums, you will only be allowed to enroll during the next Open Enrollment.

To make an enrollment change based on a qualifying status change (QSC) event, federal law requires the event to result in a gain or loss of eligibility for coverage, and your elections must meet general consistency rules. For example, if you have individual health insurance coverage and get married, you may change from individual to family coverage; however, you cannot change health insurance plans because the QSC event only changes the level of coverage eligibility. In this case, changing plans is not consistent with the nature of the QSC event.

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Chapter 60P, Florida Administrative Code, and the Internal Revenue Code govern eligibility and enrollment for the State Group Insurance program. Choose your plans carefully. Once you enroll, you must remain in the plans you select unless you have an appropriate qualifying event ( 275.23 KB ) that would allow you to make a change.


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