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Timeframes to Enroll or Make Health Care Changes

Guidelines are in place for enrolling or making changes to your health plan elections. These rules give you more flexibility when making important health care decisions affecting your life and that of your family. The guidelines are based on Internal Revenue Service (IRS) rules for pre-tax benefits. These rules also apply to Flexible Spending Accounts (FSAs).

Remember that you still need to submit documentation whenever adding dependents to your plan. See the Eligibility Rules and Definitions on this site.

Note: No person can be enrolled in more than one state health benefits plan under any circumstances. If it is determined that a person is covered in error, DHRM has the right to take corrective action.

Enrollment When Newly Eligible

To allow enrollment in health care coverage as soon as possible, the rules allow 30 calendar days for submitting enrollment action when you are newly eligible for the State Health Benefits Program.

Coverage in the health plan and/or the FSA takes effect the first day of the month coinciding with or following the hire date, as long as the agency receives your enrollment action within 30 days of that date. The count begins on the day of the event and ends 30 days later. For example, if your enrollment action is received the month after you are employed yet within 30 days of your hire date, your coverage still takes effect the first of the month after you were hired.

An employee hired on the first day of the month can have coverage the first of that month provided the agency receives the enrollment action within 30 days. See the examples in the chart below. Remember that if you are newly eligible for coverage and miss the 30-day enrollment window, you must wait until spring Open Enrollment or a qualifying life event (QME) to enroll.

Important: The Code of Virginia governs state retiree benefits. New retirees have 31 days from their retirement date to enroll. Survivors of employees legally have 60 days from the date of the employee or retiree's death, and long-term disability (LTD) participants have 31 days from the date they lost coverage as an active employee. For more information, see Retiree Fact Sheets.

Change Based on a Qualifying Mid-Year Event (QME)

Under the guidelines, an employee has 60 calendar days to submit a request to make changes based on a qualifying life event (QME) such as marriage, divorce, birth, or adoption. The count begins on the day of the event and ends 60 days later. Coverage generally takes effect the first of the month following the date your agency receives the enrollment action. So, it may be to your advantage to submit an enrollment action as early as possible. Remember, all FSA elections are prospective.

See this timeframes chart for examples of the rules, the deadlines for submitting enrollment actions and the dates that QME changes take effect.

Marriage

You have 60 days from the date of the marriage to add your new spouse to health coverage. The coverage will be effective the first of the month following the marriage or receipt of the enrollment request, whichever is later. If you get married on the first day of the month, and your agency receives your enrollment action on or before that day, the change takes effect the date of the marriage.

Divorce

You have 60 days from the date of your divorce to drop your ex-spouse and stepchildren from your health plan. Your ex-spouse and stepchildren will be removed from coverage the last day of the month in which the divorce is final, since all dependents lost eligibility for coverage when the final papers were signed.

Birth, Adoption or Placement for Adoption

You have 60 days from the day your child is born to add the newborn to your health plan. If the child is adopted, you have 60 days from the date of adoption or placement for adoption. When the enrollment action is received by the agency within the 60-day time frame, the child will be added to health plan coverage on the date of their birth, the date of the final adoption decree is signed or the date the child is placed for adoption.

If you have questions about these changes, contact your agency Benefits Administrator.