B E N E F I T S
O V E R V I E W
WHAT IS A FAMILY STATUS CHANGE ?
A family status change is a life event that may allow employees to add or drop coverage for themselves or their dependents within a specified time frame , typically within 30 to 60 days of the event ( see chart below ). You must contact Human Resources to make these types of changes by submitting a Family Status / Life Event Change Form .
These types of changes may include : ✓ Marriage or Divorce ✓ Birth or Adoption ✓ Court-Ordered Guardianship ✓ Child or Spouse loss of other coverage ✓ Dependent child reaching age 26
All payroll deductions / refunds due to plan changes will be taken on the next paycheck based on the effective date of change . Plan changes may impact year-to-date deductible , co-insurance or co-pays . For example , if you change from employee + spouse coverage to employee-only , any claims incurred would follow the new employee-only coverage level .
Use the chart below or Contact Human Resources at 817-459-6869 or employeebenefits @ arlingtontx . gov for assistance .
Adding Coverage Due To :
Marriage – A1 Birth – A1 Adoption / Placement for Adoption – A1 / 2 Layoff – A3 Loss of Coverage – A3 Court-Ordered Guardianship or Custody – A2 Dependent Daycare Added – A4 Medicaid or CHIP eligibility loss – B3
Dropping Coverage Due To :
Divorce – B2 / 5 Other Coverage – A4 Dependent Child Maximum Age – B5 Death – A1 Dependent Daycare discontinued – A3 Medicaid or CHIP eligibility – B4
Timelines and Document Requirements
A : Add / Drop required within 30 days of event B : Add / Drop required within 60 days of event
1 : Provide marriage / birth / death certificate as applicable
2 : Provide Court document signed by judge 3 : Provide proof of loss of coverage 4 : Provide proof of coverage or enrollment
5 : Provide address when dropping former spouse or dependent child reaching maximum age of 26
City of Arlington / EMPLOYEE BENEFITS GUIDE 2021
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