Enrollment

The federal law, Health Insurance Portability Accountability Act (HIPAA), allows you and your dependents to enroll in health coverage under certain conditions. Exceptions will also be made for you or your dependents if you lose health coverage offered through your spouse’s or ex-spouse’s employer.

You or your dependents may also be eligible to enroll in dental and vision coverage when lost with another employer. If you are adding dependents to your existing coverage, you and your dependents may transfer to a different carrier or healthcare option, if eligible. Premiums are not prorated. If approved, you must pay premium for the entire month in which the effective date occurs.

Identify the qualifying event(s) which caused the loss of other coverage for you and/or your eligible dependent(s).

Adding Dependents

If you acquire a new dependent during the plan year, like adding a newborn or getting married, the federal Health Insurance Portability and Accountability Act (HIPAA) may provide an opportunity for you and eligible dependents to enroll in health coverage.  If you are adding dependents to your existing coverage, the application for enrollment must be made within 30 days of a new dependent’s acquire date. 

Employees adding insurance due to the loss of eligibility for other health insurance coverage must complete application for enrollment within 60 days of the event date.  Voluntary actions resulting in loss of coverage (such as voluntary cancellation of coverage and cancellation for not paying premiums) are not qualifying events. Electing to cancel, waive or decline coverage during another plan’s enrollment period IS NOT a qualifying event.

To review what is considered a special qualifying event, appropriate document and effective dates of coverage can be found on page 3 on the enrollment change application.

If adding dependents to insurance for the first time, the following dependents are eligible for coverage: • Your spouse (legally married) • Natural or adopted children • Stepchildren • Children for whom you are the legal guardian • Children for whom the plan has qualified medical child support orders. 

Dependent children are eligible for coverage through the last day of the month of their 26th birthday.

*Required Documents: Written documentation from the employer or the insurance company on company letterhead providing the names of covered participants, date coverage ended, reason for the loss of eligibility and what coverage was lost (i.e., medical, dental, and vision).

You must also provide government issued marriage certificate or license AND one document proving proof of joint ownership along with providing the child’s birth certificate. 

Questions and enrollment forms should submitted directly to mybenefits@uthsc.edu. Secure submission of your forms can be done via the UT Secure Emailing Vault System.

You may only cancel coverage for yourself and/or your dependents if you lose eligibility or you experience an event that results in you/your dependents becoming newly eligible for coverage under another plan. There are no exceptions. You have 60 days from the date that you and/or your dependents become newly eligible for other coverage to turn in an application and proof to your agency benefits coordinator. The required proof is shown on the application.

 You may become newly eligible for other medical coverage if one of the follow events occurs:

• Marriage, divorce, legal separation, annulment • Birth, adoption/placement for adoption • Death of spouse, dependent
• New employment, return from unpaid leave, change from part-time to full-time employment (spouse or dependents)
• Entitlement to Medicare, Medicaid or TRICARE
• Court decree or order
• Open enrollment
• Change in place of residence or workplace out of the national service area (i.e., move out of the U.S.)
• Marketplace enrollment

 Once your application and required proof are received, the coverage end date will be either:

• The last day of the month before the eligibility date of other coverage
• The last day of the month that the event occurred

You may request to cancel Prepaid dental if there is no participating general dentist within a 40-mile radius of your home. If you request to cancel disability coverage, 30 days advance written notice is required.

You must notify your agency benefits coordinator of any event that causes you or your dependents to become ineligible for coverage. You must repay any claims paid in error. Refunds for any premium overpayments are limited to three months from the date notice is received.

When canceled for loss of eligibility, coverage ends the last day of the month eligibility is lost. For example, coverage for adopted children ends when the legal obligation ends. Insurance continued for a disabled dependent child ends when he/she is no longer disabled or at the end of the 31-day period after any requested proof is not given.

Divorce — If you request to terminate coverage of a dependent spouse while a divorce case is pending, such termination will be subject to laws and court orders related to the divorce or legal separation. This includes the requirements of Tennessee Code Annotated Section 34-4-106 and the requirement that you provide notice of termination of health insurance to your covered dependent spouse under Tennessee Code Annotated Section 56-7-2366. As the employee, it is your responsibility to make sure that any request to terminate your dependent spouse is consistent with those legal requirements.

Insurance Cancel Request Application

Questions and enrollment forms should submitted directly to mybenefits@uthsc.edu. Secure submission of your forms can be done via the UT Secure Emailing Vault System.

The Annual Enrollment Period is typically the first two weeks in October. The enrollment period gives you another chance to enroll in health, dental, vision, voluntary accidental death coverage, voluntary term life and disability insurance coverage. You can also make changes to your existing coverage, like increasing or decreasing voluntary term life insurance, transferring between health, dental, disability and vision options and canceling insurance.

Most changes you request start the following January 1. However, voluntary term life and disability insurance may start January 1, February 1 or March 1. This is due to the review of medical history by the insurance carriers to determine your qualification for coverage.

Benefit enrollments remain in effect for a full plan year (January 1 through December 31). However, you may cancel disability and voluntary term life coverage at any time. You may not cancel other coverage outside of the enrollment period unless eligibility is lost or there is a qualifying change or event.