Common use of Change in Family Status Clause in Contracts

Change in Family Status. A change in family status is the only exception to the rule prohibiting any change in your benefit election during a plan year. A change in family status is limited to situations where your family status has changed during the plan year and this change affects the benefit election you made earlier. The following are examples of changes in family status: - You have married or divorced; - Your spouse or child has died; - You have a new child by birth or adoption; - Your spouse begins or terminates employment; - Your or your spouse’s employment status is changed from full-time to part-time, or vice-versa; - You or your spouse take an unpaid leave of absence; or - You or your spouse have a significant change in your health coverage as a result of your spouse’s employment. If you have a change in family status during a plan year, you must submit a change in family status form to the District no later than 30 days after the change in family status. The change in family status form will be effective as soon as administratively feasible after the change is approved by the District. Most importantly, your new election must be on account of and consistent with the change in family status. Further, any new election involving an independent third-party health insurer or HMO will only be approved to the extent permitted by the independent third-party health insurer or HMO. If you do not submit the change in family status form to the District within 30 days after the change in family status, you will be required to wait until the next annual enrollment period to change your election. CLAIMS Benefits under the group health plan will be paid according to the plan’s claims procedure. If your claim for benefits under the plan is denied, in whole or in part, you may appeal according to that plan’s appeal procedure.

Change in Family Status. A change in family status is the only exception to the rule prohibiting any change in your benefit election during a plan year. A change in family status is limited to situations where your family status has changed during the plan year and this change affects the benefit election you made earlier. The following are examples of changes in family status: - ‐ You have married or divorced; - ‐ Your spouse or child has died; - ‐ You have a new child by birth or adoption; - ‐ Your spouse begins or terminates employment; - ‐ Your or your spouse’s employment status is changed from full-time full‐time to part-timepart‐time, or vice-versavice‐versa; - ‐ You or your spouse take an unpaid leave of absence; or - ‐ You or your spouse have a significant change in your health coverage as a result of your spouse’s employment. If you have a change in family status during a plan year, you must submit a change in family status form to the District no later than 30 days after the change in family status. The change in family status form will be effective as soon as administratively feasible after the change is approved by the District. Most importantly, your new election must be on account of and consistent with the change in family status. Further, any new election involving an independent third-party third‐party health insurer or HMO will only be approved to the extent permitted by the independent third-party third‐party health insurer or HMO. If you do not submit the change in family status form to the District within 30 days after the change in family status, you will be required to wait until the next annual enrollment period to change your election. CLAIMS Benefits under the group health plan will be paid according to the plan’s claims procedure. If your claim for benefits under the plan is denied, in whole or in part, you may appeal according to that plan’s appeal procedure.