Mid-Year Enrollment Changes

Mid-year enrollment/change forms must be receieved by the HR Benefits Unit within 31 days of the event date, except as required under the Health Insurance Portability and Accountability Act (HIPAA) or other applicable laws or policies. Changes must be consistent with the event type. Changes will be effective prospectively from the date the HR Benefits Unit receives the Enrollment/Change Form.

While we will require proof documentation to determine eligibility, do not wait to submit the enrollment/change form! Complete and return the enrollment/change form and contact HR Benefits.

Review the Employee and Retiree charts below for a summary of some of the more common change of status events and the mid-year enrollment changes that can be made.

The charts are only a summary of some of the permitted health plan changes and are not all inclusive.

Employee and Extra Help Mid-Year Enrollment Changes

When will my benefit change be effective?

Employment Status Events

If you experience the following event...	You may make the following change(s) within 31 days of the event…	YOU MAY NOT make these types of Changes
You become newly eligible for benefits due to change in employment status or bargaining group	Enroll yourself, if applicable Enroll your spouse/DP and other eligible dependents	Enroll, drop or change plans if your employment change does not result in you being eligible for a new set of benefits
Spouse/DP obtains health benefits in another group health plan	Drop your spouse/DP from your health coverage Drop your dependent children from your health coverage if they enroll in spouse’s or DP’s coverage Drop coverage for yourself if you enroll in your spouse’s/DP’s coverage * Proof of coverage in the other health plan required	Change health plans. Add any eligible dependents to your health coverage. Enroll yourself if you are not currently enrolled
Spouse/DP loses employment, experiences a termination of their employer’s contribution, or otherwise loses coverage or eligibility for health benefits in another group, individual, or exchange health plan. You or your dependents exhaust COBRA coverage under other group health plan.	Enroll your spouse/DP and, if applicable, eligible dependent children in your health plan Enroll yourself in a health plan if previously not enrolled because you were covered under your spouse/DP’s plan Change health plans * Proof of loss of other coverage is required	Drop health coverage for yourself or any other covered dependents
You lose employment or otherwise become ineligible for health benefits	You must drop coverage for yourself and any enrolled Dependents because you are no longer eligible for coverage	Add any Dependents
You experience a reduction in hours (e.g. full-time to part-time) that results in a significant cost increase	Drop coverage for yourself (only if there is a significant cost change and there is no other similar health plan option available) Change health plans to a less expensive plan	No change is allowed unless there is a significant reduction of the employer subsidy for medical (not FSA) coverage. Financial hardship (including due to a pay cut or reduction in hours) does not trigger the change in cost rule
You experience an unpaid leave (e.g. leave without pay) not covered by FMLA, CFRA etc. where the County will no longer be making a contribution	You may suspend coverage for yourself and dependents while on leave and reinstate coverage upon return to work if you are still eligible then	Add or Drop any dependents, change plans, or enroll if not currently enrolled
You experience an increase in hours (e.g. part-time to full-time) that results in a significant cost decrease or return from an unpaid leave (e.g. leave without pay) when the County was not making a benefit contribution	Add coverage for yourself Add your spouse/DP, or dependent children to your health coverage Change health plans to a less expensive plan	No change is allowed unless there is a significant change in the employer subsidy for health (not FSA) coverage
You return from Military leave	Prior elections at beginning of leave are reinstated unless another Change Event has occurred which permits the change
You, your spouse, or dependents enroll in a Qualified Health Plan through a Public health Insurance Marketplace	Drop your spouse/DP from your health coverage Drop your dependent children from your health coverage Drop coverage for yourself * Proof of enrollment in Marketplace Coverage is required	Add any dependents,change plans, or enroll yourself if not currently enrolled

Life and Family Events

If you experience the following event...	You may make the following change(s) within 31 days of the event…	YOU MAY NOT make these types of Changes
Marriage or Commencement of Domestic Partnership (DP)	Enroll yourself, if applicable Enroll your new spouse/DP and other eligible dependents Drop health coverage (to enroll in your spouse/DP’s plan) Change health plans	Drop health coverage and not enroll in spouse/DP’s plan
Divorce, Legal Separation, or Termination of Domestic Partnership	Drop your spouse/DP from your health coverage Drop dependent child(ren) with proof of other coverage under spouse’s plan Children of a Domestic Partner MUST be dropped (regardless of whether they enroll in other coverage) as they are no longer eligible dependents Enroll yourself and your dependent children if you or at least one dependent child was previously enrolled in your spouse/DP’s plan and lost eligibility Change health plans	Drop health coverage for yourself
Gain a child due to birth or adoption	Enroll yourself, if applicable Enroll the eligible child and any other eligible dependents Change health benefit plans * Adoption placement papers are required	Drop health coverage for yourself or any other covered individuals without proof of enrollment in spouse/DP’s plan
Child requires coverage due to a Qualified Medical Child Support Order (QMCSO)	Add child named on QMCSO to your health coverage (enroll yourself, if applicable and not already enrolled) Drop child named on QMCSO if required by QMCSO Change health plans, when options are available, to accommodate the child named on the QMCSO	Drop health coverage for yourself Make any other changes except as required by the QMCSO
Loss of a child’s eligibility (e.g. child reaches the maximum age for coverage) or death of a dependent child	Drop the child who lost eligibility from your health coverage Change health plans to accommodate newly removed dependent(s) and remaining covered individuals	Drop health coverage for yourself or any other covered individuals
Death of a spouse/DP	Drop the deceased dependent from your health coverage Enroll yourself and/or any eligible children if lost eligibility under spouse’s/DP’s plan Change health plans	Drop health coverage for yourself or any other covered individuals
Change of home address outside of plan service area that causes a loss of eligibility for coverage	Change health plans if you are enrolled in a medical HMO and move out of their service area	Cannot add eligible dependents Does not apply to County Health Plan, dental or vision coverage

Medicare, Medicaid, Medi-Cal, SCHIP and CHIP Events

If you experience the following event...	You may make the following change(s) within 60 days of the event…	YOU MAY NOT make these types of Changes
Covered person has become entitled to Medicare	Drop coverage for the Dependent who became entitled to Medicare, with proof of Medicare enrollment If Employee becomes entitled to Medicare, may drop all coverage (self and dependents) * Documentation required	Drop health coverage for yourself or any other covered individuals who are not newly Medicare, Medicaid, Medi-Cal, or SCHIP eligible Change Plans Enroll yourself
Covered person has lost entitlement to Medicare	Add coverage for the Dependent who lost entitlement to Medicare, with proof of Medicare disenrollment	Change Plans
Covered person has become entitled to Medicaid, Medi-Cal, or SCHIP	Drop coverage for the Dependent who became entitled to Medicaid, Medi-Cal, or SCHIP with proof of Medicaid/Medi-Cal or SCHIP enrollment Drop coverage for yourself with proof of your own Medicaid/ Medi-Cal/SCHIP enrollment If you or an eligible dependent is gaining eligibility for premium assistance, may enroll those gaining eligibility for premium assistance only if not already enrolled in County coverage * Documentation required	Drop health coverage for yourself or any other covered individuals who are not newly Medicaid, Medi-Cal, or SCHIP eligible Change Plans Enroll yourself
Covered person lost entitlement to Medicaid, MediCal or SCHIP	Add the person who lost entitlement to Medicaid, Medi-Cal, or SCHIP	• Drop coverage for yourself or any enrolled dependents • Change plans

Retiree Mid-Year Enrollment Changes

What is a Qualifying Event?

Employment Status Events

If you experience the following event...	You may make the following change(s) within 31 days of the event…	YOU MAY NOT make these types of Changes
You retire, transferring from active benefits to retiree benefits	Change medical plans Enroll in a retiree dental plan Waive health coverage for yourself and/or dependents. Spouse/RDP has independent waiver rights. Enroll eligible dependents	You may not be enrolled in an employee or other retiree benefits
Spouse/RDP obtains medical or dental benefits in another group health plan or public exchange	Permanently cancel medical coverage for spouse/RDP Waive dental coverage for spouse/RDP	Change health plans Waive health coverage
Spouse/RDP loses coverage for medical and dental benefits in another group medical or dental plan (Proof of loss of other coverage is required)	Enroll yourself and/or spouse/RDP in a health plan, if eligible and previously waived Add dependent child(ren) to a medical plan if eligible and previously waived, only if waived along with retiree and retiree is also re-enrolled Change health plans	Enroll dependent children in a medical plan unless the retiree is enrolling

Life/Family Events

If you experience the following event...	You may make the following change(s) within 31 days of the event date...	YOU MAY NOT make these types of changes
Marriage or Commencement of Registered Domestic Partnership (RDP)	Enroll in or waive health coverage for your new spouse/RDP and other newly eligible dependents1 Waive health coverage for newly eligible dependents if your coverage is also waived Change health plans	Waive health coverage for yourself and previously eligible children1 Enroll if not already enrolled
Divorce, Legal Separation, or Termination of Registered Domestic Partnership	Cancel health coverage for your spouse/RDP Enroll yourself and your dependent children in health coverage if you or they were previously enrolled in your spouse/RDP’s health plan and only if a signed waiver is on file Cancel health coverage for dependent children	Change Health Plans
Gain a child due to birth or adoption	Enroll in or waive health coverage for the newly eligible dependent Adoption placement papers are required Change health plans
Previously ineligible child requires coverage due to a Qualified Medical Child Support Order (QMCSO)	Add child named on QMCSO to your health coverage (enroll yourself, if eligible and waiver is on file) Drop child named on QMCSO if required by QMCSO Change health plans, when options are available, to accommodate the child named on the QMCSO	Make any other changes except as required by the QMCSO
Loss of a child’s eligibility (e.g. child reaches the maximum age for coverage)	Drop the child who lost eligibility from your health coverage	Change health plans
Death of a Dependent (Spouse/RDP or Child)	Drop the deceased dependent from your health coverage Enroll in health coverage if lost eligibility under spouse’s/RDP’s plan and waiver is on file Change health plans
Change of home address outside of plan service area that causes a loss of eligibility for coverage	Change health plans if you are enrolled in a medical or dental HMO and move out of their service area
Death of retiree	Eligible dependents may enroll at the time of the event or continue to waive if previously waived prior to retirees death until Medicare eligibility	Surviving dependents must enroll or continue to waive

Medicare, Medicaid, Medi-Cal and SCHIP Events

If you experience the following event...	You may make the following change(s) within 31 days of the event date...	YOU MAY NOT make these types of changes
Retiree has become entitled to Medicare	Change medical plans Last opportunity to enroll yourself and dependent children in a medical plan, if previously waived. Spouse can continue to waive until they reach their own Medicare eligibility. Eligibility for coverage will be permanently canceled if no enrollment within 60 days of Medicare eligibility
Covered person has become entitled to Medicaid, Medi-Cal, or SCHIP	Drop coverage for the Dependent who became entitled to Medicaid, Medi-Cal, or SCHIP with proof of Medicaid/Medi-Cal or SCHIP enrollment Drop coverage for yourself with proof of your own Medicaid/Medi-Cal/SCHIP enrollment If you or an eligible dependent is gaining eligibility for premium assistance, may enroll those gaining eligibility for premium assistance only if not already enrolled in County coverage Documentation required	Drop health coverage for yourself or any other covered individuals who are not newly Medicaid, Medi-Cal, or SCHIP eligible Change Plans Enroll yourself
Covered person lost entitlement to Medicaid, Medi-Cal or SCHIP	Add the person who lost entitlement to Medicaid, Medi-Cal, or SCHIP	Drop coverage for yourself or any enrolled dependents Change plans

Employee Assistance Program (EAP)

EAP provides up to six sessions with a licensed counselor to provide guidance and support to help you and your family manage daily stresses, grievance, traumatic events and develop fulfilling relationships both personally and professionally. EAP is available to all County of Sonoma employees and their family members.

CareCounsel Health Advocacy

CareCounsel's Health Advocacy program is a special benefit sponsored by the County that can help you understand and effectively navigate your health benefits.

Benefit Forms, Plan Documents and Important Information

Find all the forms you need to enroll, change or cancel your benefits. Looking for plan information? You can find Summary of Benefits and Coverages (SBC's) and Evidence of Coverage (EOC's, detailed plan information) in plan documents.

Benefit Guides

Find the Employee, Extra Help and Retiree guides for the last five years!