Overview

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    Qualifying Events and IRS Code Section 125

    IRS Code Section 125

    Premiums for medical, dental, vision insurance and/or certain supplemental policies and contributions to Flexible Spending Accounts (FSA) are deducted through a Cafeteria Plan established under Section 125 of the Internal Revenue Code (IRC) and are pre-tax to the extent permitted. Under Section 125, changes to an employee’s pre-tax benefits can be made ONLY during the Open Enrollment period unless the employee or qualified dependents experience a qualifying event and the request to make a change is made within 30 days of the qualifying event.

    Making Benefit Plan Changes

    Under certain circumstances, employee may be allowed to make changes to benefit elections during the plan year, if the event affects the employee, spouse or dependent(s) coverage eligibility. An “eligible” qualifying event is determined by the Internal Revenue Service (IRS) Code, Section 125. Any requested changes must be consistent with and on account of the qualifying event. To ensure all life events are reviewed in a timely manner, please email our Benefits Specialist, Jamie Hickey at hickeyj@martinschools.org once you have experienced a life event that will effect your benefits.

    Examples of Qualifying Events:
    • Employee gets married or divorced
    • Birth of a child
    • Employee gains legal custody or adopts a child
    • Employee’s spouse and/or other dependent(s) die(s)
    • Employee, employee’s spouse and/or dependent(s) terminate or start employment
    • An increase or decrease in employee's work hours causes eligibility or ineligibility
    • A covered dependent no longer meets eligibility criteria for coverage
    • A child gains or loses coverage with an ex-spouse
    • Change of coverage under an employer’s plan
    • Gain or loss of Medicare coverage
    • Losing eligibility for coverage under a State Medicaid or CHIP (including Florida Kid Care) program (60 day notification period)
    • Becoming eligibility for State premium assistance under Medicaid or CHIP (60 day notification period)

    Please Note: Purchasing or dropping an individual policy for the employee or employee dependent IS NOT a qualifying event and does not permit adding or dropping coverage for employee or employee dependent from the group health plan outside of Open Enrollment.

    Qualifying events allow employee to only make changes to the employee's existing coverage, it does not allow employee to change employee's current insurance plan(s).

    Job Changes

    Some job changes or bargaining unit changes result in gain, loss or change in insurance benefits. See Qualifying Event section or contact the Risk & Employee Benefits Department for more information. Please check your employee payroll stub following a job change to ensure payroll deductions continue without interruption. Employee will be responsible for any missed deductions.

30 day rule

Qualifying Events Guide

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