Qualified Status Changes

Below you will find the University’s recognized Qualified Status Changes. In order to make a status change to your benefit selections, you will need to download and complete both the Change In Status Form and the Benefits Enrollment Form.

Completing the Status Change Forms

On the Change in Status Form, please provide the reason you are requesting the change. Next, select the Benefits Enrollment Form that corresponds to your position with the University (i.e., staff, full-time faculty, part-time faculty, etc.) and complete only the sections that pertain to the changes you are making for the life event. All other elections will remain the same. Forms must be accompanied by supporting documentation of the life event. Please see the Qualified Status Change Request Requirements for examples.

IMPORTANT NOTE: Medical, dental, vision plan changes cannot be made for a qualified life event. You can only modify your tier level to accommodate an eligible dependent(s) or remove a dependent(s).

A change to your benefit elections can only be made within 60 days of the qualified life event.

  • For an event date that occurs on the first day of a month, the coverage becomes effective the first of that same month.

    Marriage Life Event Example: If the employee was married on October 1st and wants to add their new spouse to their benefits, the spouse’s coverage would begin effective October 1. The employee must complete the status change forms and provide a copy of their marriage certificate within 60 days of their date of marriage.

    NOTE: Coverage is only processed to begin based on the event date for a qualified status change. If you submit your paperwork on October 31st, the coverage will begin retroactively on October 1st.
  • For an event date that occurs after the first day of a month, the coverage becomes effective the first of the next month.

    Marriage Life Event Example: If the employee was married on October 13th and wants to add their new spouse to their benefits, the spouse’s coverage would begin effective November 1. The employee must complete the status change forms and provide a copy of their marriage certificate within 60 days of their date of marriage.

    NOTE: Coverage is only processed to begin based on the event date for a qualified status change. If you submit your paperwork on November 30th, then the coverage will begin retroactively on November 1st.

You may either fax, mail, or deliver the forms in person to the Benefits Department.

University of Pittsburgh
Benefits Department
320 Craig Hall
200 South Craig Street
Pittsburgh, PA 15260
Fax: (412) 624-3485
 

Qualified Status Change Request Requirements

Birth or Legal Adoption

The addition of a child to your family is a qualifying life event to make changes to your benefits enrollment. You must complete the Change in Status Form and Benefits Enrollment Form and return them to the Benefits Department within 60 days of the birth or adoption being finalized. If you are outside of the 60-day deadline to submit your life event request, you will need to wait until the annual open enrollment period to make changes. There may be other options to cover your child under CHIP or the Healthcare Marketplace if you are unable to meet the 60-day deadline.

Accepted Documentation

  • Birth certificate
  • Verification of birth document
    • NOTE: This document is accepted as a placeholder until you receive the official birth certificate. A copy of the birth certificate should also be submitted upon your receipt, which should be within 31 days.
  • Legal court ordered document confirming the adoption of child.

Medical, Dental, Vision

  • You have the option to add your child to your existing policies for coverage to begin first of the month following the date of birth or adoption.
    • IMPORTANT: Newborns are automatically covered under the mother’s insurance for the first 31 days following their birth. You must take action within 60 days to continue your newborn’s coverage.

Flexible Spending Accounts

  • Health Care FSA
    • You may newly enroll or increase your pre‐tax deduction to begin the first of the month following the date of birth or adoption. This election would remain in effect for the remainder of the plan year.
  • Dependent Care Account
    • You may newly enroll or increase your pre‐tax deduction to begin the first of the month following the date of birth. This election would remain in effect for the remainder of the plan year.
  • Parking FSA
    • No changes are permitted to be made for the birth event.
  • Mass Transit
    • No changes are permitted to be made for a birth event.

Life Insurance

  • You may newly enroll or change your optional life and/or optional AD&D coverage for the birth event.
    • NOTE: Optional life insurance can be increased by one level for a qualified life event or during open enrollment. An increase of more than one level may be subject to Evidence of Insurability.
  • You may newly enroll in child life insurance for your child.
  • You can update the beneficiary to your life insurance policy, if applicable. More information can be found at http://www.aetna.com/group/upitt/reg/life_bms.htm.

Retirement Savings Plan

Change in Marital Status

A change in your marital status, such as marriage or divorce, provides you with the opportunity to make changes to your benefits enrollment. You must complete the Change in Status Form and Benefits Enrollment Form and return them to the Benefits Department within 60 days of the marriage date or the date of a divorce being finalized. If you are outside of the 60-day deadline to submit your life event request, you will need to wait until the next annual open enrollment period to make changes.

In the event of a marriage, you also have the option to waive University coverage to be added to your spouse’s employer-sponsored plan. You will be required to complete the Change in Status and Enrollment Forms and a copy of your marriage certificate acceptable documentation and return them to the Benefits Department within 60 days of the date of marriage. In the event of a divorce and if you are covered under a spouse’s employer sponsored plan, you will need to complete the Change in Status Form and Benefits Enrollment Form and include a copy of your divorce decree and return them to the Benefits Department within 60 days of the divorce being finalized in order to enroll in University coverage.

Accepted Documentation

  • Copy of the Marriage Certificate
  • Copy of the Divorce Decree

Medical, Dental, and Vision

  • In the event of a marriage, you have the option to add your spouse to your existing policies for coverage to begin the first of the month following your date of marriage.
  • In the event of a divorce, you must remove your ex-spouse from your existing policies for coverage to end the first of the month following the date of the Divorce Decree.
    • NOTE: If you and your ex-spouse no longer share a residence, please update the Benefits Department with their correct mailing address at hr-benque@pitt.edu. We will need this information for the purpose of offering COBRA to the ex-spouse.

Flexible Spending Accounts

  • Health Care FSA
    • In the event of a marriage, you have the option to newly enroll or increase your pre‐tax deduction effective the first of the month following the date of marriage. This election would remain in effect for the remainder of the plan year.
    • In the event of a divorce, you have the option to decrease or suspend your pre‐tax deduction effective the first of the month following the date of the decree. This election would remain in effect for the remainder of the plan year.
  • Dependent Care
    • No changes are permitted to be made for a marriage/divorce event.
  • Parking FSA
    • No changes are permitted to be made for a marriage/divorce event.
  • Mass Transit
    • No changes are permitted to be made for a marriage/divorce event.

Life Insurance

  • You may newly enroll or change your optional life and/or optional AD&D coverage for the marriage/divorce event.
    • NOTE: Life insurance can be increased by one level of coverage for a qualified life event or during open enrollment. An increase of more than one level of coverage may be subject to Evidence of Insurability.
  • You have the option to enroll your new spouse in life insurance in the event of a marriage.
    • NOTE: You may elect option 1 when newly enrolling in spouse life insurance. If you elect any coverage over option 1, your spouse may be subject to the Evidence of Insurability. Options 5 and 6 always require the Evidence of Insurability to completed and submit for review by Aetna. For more information regarding the options for life insurance coverage for your new spouse, please visit: http://hr.pitt.edu/sites/default/files/uploads/lifeinsurance_17.pdf.
  • You must waive spousal life insurance in the event of a divorce.
  • You can update the beneficiary to your life insurance policy, if applicable. More information can be found at http://www.aetna.com/group/upitt/reg/life_bms.htm.

Retirement Savings Plan

Death of a Dependent

When you experience the loss of a dependent, you may make changes to your benefits. Please complete the Change in Status Form and Benefits Enrollment Form and return them to the Benefits Department within 60 days of the passing of your dependent.

Accepted Documentation

  • Copy of the Death Certificate

Medical, Dental, Vision

  • You can remove your deceased spouse or child from your existing policies for coverage to end the first of the month following the event date.

Flexible Spending Accounts

  • Health Care FSA
    • For a spouse, you may newly enroll, increase, decrease, or suspend your pre‐tax deductions effective the first of the month following the event date. This election would remain in effect for the remainder of the plan year.
    • For a child, you may decrease or suspend your pre‐tax deductions effective the first of the month following the event date. This election would remain in effect for the remainder of the plan year.
  • Dependent Care Account
    • For a spouse, you may newly enroll, increase, decrease, or suspend your pre‐tax deductions effective the first of the month following the event date. This election would remain in effect for the remainder of the plan year.
    • For a child, you may decrease or suspend your pre‐tax deductions effective first of the month following the event date. This election would remain in effect for the remainder of the plan year.
  • Parking FSA
    • No changes are permitted to be made for this life event.
  • Mass Transit
    • No changes are permitted to be made for this life event.

Life Insurance

  • In the event of a spouse’s death, you may newly enroll or change your optional life and/or optional AD&D insurance elections.
  • In the event of child’s death, you may newly enroll or change your optional life and/or optional AD&D insurance elections.
  • In the event of a spouse’s death, you may waive your enrollment in the spousal life insurance policy.
  • In the event of a child’s death, you may waive your enrollment in the child life insurance policy.
  • You can update the beneficiary to your life insurance policy, if applicable. More information can be found at http://www.aetna.com/group/upitt/reg/life_bms.htm.

Retirement Savings Plan

Gained Coverage

Gaining coverage through an employer-sponsored plan or state-sponsored programs such as Medicaid, CHIP, etc. is considered a qualified life event to remove you, your spouse and/or child(ren) from your benefits. You must complete the Change in Status Form and Benefits Enrollment Form and return them to the Benefits Department within 60 days of the eligibility and/or effective start date of the coverage. If you are outside of the 60-day deadline to submit your life event request, you will need to wait until the next annual open enrollment period to make changes.

Accepted Documentation

  • Confirmation statement of benefits that outlines the coverages (i.e., medical/dental/vision), enrollee(s), and effective start date of coverage.
  • Letter from employer’s human resources department or insurance company that outlines coverages (i.e., medical/dental/vision), covered person(s), and effective start date of coverage.
  • Letter or statement that you/your dependents are newly eligible for state-sponsored coverage.

Medical, Dental, Vision

  • You may cancel your own policy and/or remove a dependent(s) from your existing policies for coverage to end the first of the month following the effective date of other coverage.
    • Employee gaining coverage may waive their existing policies based on the coverage elected on the other employer-sponsored plan. For example, if you had only medical and dental with your previous insurance company, you would only be able to enroll in University medical and dental at this time and you cannot elect vision coverage because it is not something that was recently termed. The coverage would end first of the month following the effective date of other coverage.

Flexible Spending Accounts

  • Health Care FSA
    • No changes are permitted to be made for the gaining coverage event.
  • Dependent Care
    • No changes are permitted to be made for the gaining coverage event.
  • Parking FSA
    • No changes are permitted to be made for the gaining coverage event.
  • Mass Transit
    • No changes are permitted to be made for the gaining coverage event.

Life Insurance

  • You may reduce or terminate your optional life and/or optional AD&D coverages for the gaining coverage event.
  • You may reduce or terminate the spousal life insurance election for the gaining coverage event.
  • You may reduce or terminate the child life insurance for the gaining coverage event.

Loss of Coverage

A loss of coverage through an employer-sponsored plan or state-sponsored programs such as Medicaid, CHIP, etc. is considered a qualified status change to add your spouse and/or child(ren) to your benefits. You must complete the Change in Status Form and Benefits Enrollment Form and return them to the Benefits Department within 60 days of the loss of the coverage. If you are outside of the 60-day deadline to submit your life event request, you will need to wait until the next annual open enrollment period to make changes.

Accepted Documentation

  • COBRA letter from the former employer (please provide a full copy)
  • Letter from employer’s human resources department or insurance company that indicates what coverage(s) are terminating (i.e., medical/dental/vision), covered person(s) and effective termination date of coverage(s).
  • Letter or statement that you/your dependents are no longer eligible for state-sponsored coverage (i.e., CHIP eligibility, loss of Medicaid eligibility)
  • Dependent documentation must be submitted for a spouse and/or child(ren) that you are requesting to be added to benefits due to loss of coverage. Please see the documentation requirements for dependents on the Benefits Eligibility page.

Medical, Dental, Vision

  • You may newly enroll in and/or add a dependent(s) to your existing policies for coverage to begin the first of the month following the effective end date of other coverage.
    • Employees losing coverage can make elections based on the coverage(s) lost on from their employer-sponsored plan. For example, if you had only medical and dental with your previous insurance company, you would only be able to enroll in University medical and dental at this time and you cannot elect vision coverage because it is not something that was recently termed. The coverage would begin the first of the month following the effective end date of other coverage. 

Flexible Spending Accounts

  • Health Care FSA
    • No changes are permitted to be made for the loss of coverage event.
  • Dependent Care
    • No changes are permitted to be made for the loss of coverage event.
  • Parking FSA
    • No changes are permitted to be made for the loss of coverage event.
  • Mass Transit
    • No changes are permitted to be made for the loss of coverage event.

Life Insurance

  • You have the option to newly enroll or change your optional life and/or optional AD&D coverages for the loss of coverage event.
    • Optional life insurance can be increased only by one level for a qualified life event or during the open enrollment period. An increase of more than one level may be subject to Evidence of Insurability.
  • You may newly enroll or change the spousal life insurance election for the loss of coverage event.
    • Spousal life insurance can be increased by only one level of coverage for a qualified status change or during the open enrollment period. An increase of more than one level of coverage may be subject to Evidence of Insurability. Options 5 and 6 are always subject to Evidence of Insurability. For more information regarding the levels of coverage, please visit http://hr.pitt.edu/sites/default/files/uploads/lifeinsurance_17.pdf.
  • You may newly enroll in the child life insurance for the loss of coverage event.