Effective Dates
The effective date of Qualifying Life Event (QLE) changes is always the 1st of the month following the QLE date, with the exception of birth, adoption, legal custody or guardianship QLE changes. For all Flexible Spending Account changes, if a QLE is submitted during the plan year, benefits and payroll processing deadlines will determine which month and plan year the change will take effect.
Documentation & QLE Submission Window
Documentation is required every time changes are requested due to a life event. While it does not need to be submitted at the same exact time of the QLE request, acceptable documents MUST be added into the Enrollment Portal within the allotted 30-day QLE window in order for any QLEs to be approved.
- The 30-day window originates on the date the spouse/dependent loses eligibility for coverage or begins new employment, and stretches 30 days before and 30 days after for the QLE request date. Therefore, the earliest a request may be made is 30 days before the QLE date.
- When adding multiple dependents to a plan, all dependents being added must be shown on the documentation as having been affected by the life event (gained coverage; lost coverage; etc).
The gain or loss of Medicaid or the Children’s Health Insurance Program (CHIP) allows employees a 60 day QLE window rather than the 30 days that are granted for all other request types.
Premium Adjustments
Employees pay their State Health Plan premiums on a prepaid basis (one month ahead). If you change your health plan coverage, NC State may refund/charge multiple premiums to you in your paycheck following the approval of any changes you requested. Employees pay NCFlex premiums during the same month as the benefit period. If your changes are approved after payroll lockout, adjustments to your premiums will reflect in your following paycheck.
Important Notes
QLE & Document Submission - It is HIGHLY recommended that you submit your request and documents as soon as possible so that our team may review and advise you with any changes required within your 30 day window. QLE changes that are approved after the payroll lockout point (generally the 10th of each month) may not show up in your paycheck until the following month.
Plan Changes - The State Health Plan and NC Flex Program do not allow a change in medical plans, dental, vision or cancer plan options as a result of a Status Change event (for example, low option to high option, or 70/30 plan to an 80/20 plan). A QLE will not enable an employee to enroll in or cancel the Core AD&D benefit.
Core Vision - If the employee is enrolled in the Core Vision and his/her spouse and/or dependent loses vision coverage at another employer, the employee may move to a different plan (Basic of Enhanced Coverage) to cover the family. This change requires a request for an exception to be submitted to the benefits team. This request is then sent to NC Flex on the employee’s behalf. If approved, instructions will be sent directly to the enrollment vendor to make the change and the benefits team will be able to notify you.
State Health Plan Documentation Requirements
NC Flex Documentation Requirements (NCFlex changes only)
If an employee does not submit the required documentation within their 30-day window, then that employee would have to experience another QLE, or wait until the next Open Enrollment period in order to make any benefits changes. If the documents submitted within the 30-day window do not meet the State Health Plan & NC Flex requirements, and no additional documents are uploaded, then the employee would also have to experience another QLE, or wait until the next Open Enrollment period in order to make any benefits changes.