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Medicaid or Medicare Eligibility

A change in eligibility for Medicaid, Medicare, or other federal/state agency benefits will allow you to make changes to your benefit plans outside of Open Enrollment. You must make the change within 60 days of becoming eligible for Medicaid and within 30 days of becoming eligible for Medicare. The eligibility change can be experienced by the employee, spouse, or dependent.

Documentation

Accepted Documentation for Gain of Medicaid or Medicare Eligibility:

  • Statement of benefits that outlines the coverages (i.e., medical/dental/vision), enrollee(s), and effective start date of coverage.
  • Government-issued letter or statement that you/your dependents are newly eligible for state-sponsored coverage.

Accepted Documentation for Loss of Medicaid or Medicare Eligibility:

  • Government-issued letter or statement that you/your dependents are no longer eligible for state-sponsored coverage.

In addition, when newly adding a spouse and/or dependent(s) due to loss of non-IU coverage, dependent documentation (i.e. marriage certificate, birth certificate, etc.) must be submitted.

Medical and Dental Coverage

You may take the following actions:

  • Add or discontinue coverage for the affected individual(s) (yourself, your spouse, or dependents).
  • Enroll in or drop coverage if the employee had the change in eligibility.

Tax Saver Benefit Plans

You may take the following actions:

Health Care:

  • Add, increase, or decrease coverage.
(Consistency rule is satisfied if change corresponds with a Life Event Change that affects either eligibility for coverage under Plan or eligibility of expenses under applicable IRS regulations.)

Resources

Make Benefit Changes