You, Your Spouse or Dependent Lose or Gain Group Coverage
If you are eligible for health and flexible benefits coverage, you may enroll or change your enrollment from Single or Family, from one plan or option to another, or make any combination of these changes when you or an eligible family member loses or gains coverage under any other group plan. You must enroll or change your enrollment within 31 day after the loss or gain of coverage. You can change your premium conversion status if the enrollment change is on account of and consistent with a qualifying event. A qualifying life event allows participants in cafeteria plans to change their election outside of Open Enrollment.
You or your spouse lose coverage through other employment
Within 31 days of the qualifying event, you may/must:
- Enroll eligible dependent(s)
- Enroll in coverage
- Change coverage tier
- Change coverage option to elect new coverage for you, you+spouse, or you+child(ren), or you+family
Documentation required:
- Letter from other employer documenting loss of coverage and reason for loss is required
- Social Security Numbers and dependent verification for each dependent you wish to cover
You, your spouse, or enrolled dependent are covered under a qualified health plan, and then you lose eligibility, such as through other employment, Medicaid, State Children’s Health Insurance Program (SCHIP) or Medicare
Within 31 days of the qualifying event, you may/must:
- Change coverage tier
- Enroll eligible dependent(s)
- Enroll in coverage
- Change coverage option to elect new coverage for you, you+spouse, or you+child(ren) or you+family
Documentation required:
- Social Security Numbers and dependent verification for each dependent you wish to cover
- Letter from other employer, Medicaid or Medicare documenting the date and reason for loss or discontinuation required
* NOTE: For loss of Medicaid or SCHIP coverage, you have 60 days for actions above.
Loss of last dependent(s) that impact your benefit tier
Within 31 days of the qualifying event, you may/must:
- Change coverage tier
- Change coverage option to elect new coverage for you, or you+spouse, or you+child(ren)
Documentation required:
- Provide documentation stating the reason and date eligibility was lost unless the reason for loss of coverage is because of reaching age 26
Your former spouse loses other qualified coverage, resulting in loss of your dependent child(ren)’s coverage under former spouse’s plan
Within 31 days of the qualifying event, you may/must:
- Enroll eligible dependent(s)
- Enroll in coverage for you and your eligible dependent(s)
- Change coverage options to elect new coverage for you+child(ren)
- Increase coverage tier
Documentation required:
- Social Security Numbers and dependent verification for each dependent you wish to cover
- Letter from other plan documenting name(s) of everyone who lost coverage, date, reason and when coverage was lost
Gain of coverage due to other employer’s Open Enrollment
*NOTE: The plan year can be the same, but open enrollment dates must be different.
Within 31 days of the qualifying event, you may/must:
- Change coverage tier to remove spouse and/or dependent(s)
- Change coverage option to elect new coverage for you, you+spouse, or you+child(ren)
- Discontinue coverage
Documentation required:
- Letter from other plan documenting name(s) of everyone who lost coverage, date, reason and when coverage was lost
Loss of coverage due to other employer’s open enrollment
*NOTE: The plan year can be the same, but open enrollment dates must be different.
Within 31 days of the qualifying event, you may/must:
- Enroll eligible dependent(s)
- Enroll in coverage
- Change coverage option to elect new coverage for you, you+spouse, or you+child(ren), or you+family
- Change coverage tier
Documentation required:
- Social Security Number for each dependent you wish to cover
- Letter from other plan documenting name(s) of everyone who lost coverage, date, reason and when coverage was lost
You and your spouse acquire new coverage under spouse’s employer’s plan
Within 31 days of the qualifying event, you may/must:
- Change tier to your coverage
- Discontinue coverage – you must document that all members removed from the State Health Benefit Plan or the Flexible Benefits Program coverage are covered under the other employer’s plan
- Change coverage option to elect new coverage for you, or you+ child(ren),
Documentation required:
- Letter from other plan documenting your effective date of coverage and names of covered dependents
Your spouse or your only enrolled dependent’s employment status changes, resulting in a gain of coverage under a qualified plan other than from SHBP or the Flexible Benefits Program
Within 31 days of the qualifying event, you may/must:
- Change coverage tier to remove spouse and/or dependent(s)
- Change coverage option
- Discontinue coverage
Documentation required:
- Letter from other employer documenting coverage enrollment required
- Everyone removed from coverage under the SHBP must be enrolled in the plan – this includes coverage acquired due to the other employer’s annual enrollment
You or your spouse is activated into military service
Within 31 days of the qualifying event, you may/must:
- Enroll in coverage
- Change coverage option to elect new coverage for you, you+spouse or you+child(ren), or you+family
- Change coverage tier
- Discontinue coverage
Documentation required:
- Social Security Number and dependent verification for each dependent you wish to cover
- Copy of orders required
How to Request a Change:
Changes must be made within 31 calendar days following the event. Changes in eligibility for PeachCare or Medicaid must be made within 60 calendar days. There will be no changes or refunds allowed if a timely request is not made.
Any changes will go into effect the first of the month following the qualifying live event. . However, within the State Health Benefit Plan, when you change your coverage based on the acquisition of dependents, the coverage effective date for the new coverage may be retroactive to the date of the acquisition of the dependent in some circumstances or may be the first of the month following the request to change coverage.
If you have questions regarding a change in any of your benefit coverages, first call your agency’s benefits coordinator. If you need further information about eligibility for health coverage, call the State Health Benefit Plan at 1-800-610-1863. For questions regarding your Flexible Benefits coverages, call GaBreeze Benefits Center at 1-877-342-7339. Some Flexible Benefit status changes can also be made through GaBreeze online at www.gabreeze.ga.gov.
Eligibility Certification & Verification
Verification documents supporting Qualifying Event Change requests and newly added eligible dependents may be required. If eligibility verification is requested, supporting documentation must be provided within the specified timeframe. Please note that the State Health Benefit Plan operates independently of the Flexible Benefits Program. As a result, an employee may receive a separate request for similar information for the health plan verification.
Other life events affecting your benefits:
