Special Qualifying Events
If you do not elect coverage as a new employee, you (and your eligible dependents) may be able to enroll in health and/or dental coverage under certain conditions. The chart below describes the criteria which would allow an employee (and/or their dependents) to enroll under the Special Qualifying Event option, the documentation required to verify the qualifying event, and the effective date of the new coverage. Requests to enroll under a Special Qualifying Event and any supporting documentation must be received within 60 days of the event.
| QUALIFYING EVENT | DOCUMENTATION REQUIRED | EFFECTIVE DATE |
|---|---|---|
| Death of spouse or ex-spouse | Copy of death certificate and written documentation from the employer on company letterhead providing names of covered participants and date coverage ends. | Day after loss of coverage OR first day of the month following loss of coverage |
| Divorce | Copy of the signed divorce decree and written documentation from the employer on company letterhead providing names of covered participants and date coverage ends. | Day after loss of coverage OR first day of the month following loss of coverage |
| Legal separation | Copy of the agreed order of legal separation and written documentation from the employer on company letterhead providing names of covered participants, date coverage ends, and the reason why coverage ended. | Day after loss of coverage OR first day of the month following loss of coverage |
| Loss of eligibility (does not include a loss due to failure to pay premiums or termination of coverage for cause) | Written documentation from the employer or the insurance company on company letterhead providing the names of covered participants, date coverage ends and the reason for the loss of eligibility. | Day after loss of coverage OR first day of the month following loss of coverage |
| Loss of coverage due to exhausting lifetime benefit maximum | Written documentation from the insurance company on company letterhead providing the names of covered participants, date coverage ended and stating that the lifetime maximum has been met. | Day after loss of coverage OR first day of the month following loss of coverage |
| Loss of TennCare (does not include a loss due to failure to pay premiums) |
Written documentation from TennCare providing the names of covered participants, date coverage ended and the reason why coverage has ended. | Day after loss of coverage OR first day of the month following loss of coverage |
| Termination of spouse's or ex-spouse's employment (voluntary and non-voluntary) | Written documentation from the employer on company letterhead providing names of covered participants, date coverage ended and reason why coverage ended. | Day after loss of coverage OR first day of the month following loss of coverage |
| Employer eliminated contribution to spouse's, ex-spouse's or dependent's insurance coverage (total contribution, not partial) | Written documentation from the employer on company letterhead providing names of covered participants, date contribution amount changed and date coverage ended. | Day after loss of coverage OR first day of the month following loss of coverage |
| Spouse's or ex-spouse's work hours reduced causing loss of eligibility for insurance coverage | Written documentation from the employer on company letterhead providing names of covered participants, date coverage ended and reason why coverage ended. | Day after loss of coverage OR first day of the month following loss of coverage |
| Employees who are acquiring a new dependent may also add other previously eligible dependents to coverage at the same time. This is considered a qualifying event and the documentation listed below will also be required. | ||
| Acquires a new dependent--spouse (and adding other previously eligible dependents) |
Copy of marriage certificate. | Date of marriage OR first day of the month following marriage |
| Acquires a new dependent--newborn (and adding other previously eligible dependents) |
Copy of birth certificate for newborn. | Date of birth |
| Acquires a new dependent--adoption/legal custody (and adding other previously eligible dependents) |
Copy of adoption documents. | Date of adoption or legal custody |
If you are currently enrolled in health coverage and have a dependent approved for coverage through a special enrollment qualifying event, you and your covered dependents may transfer to another healthcare option.