SECTION 260:40-17-4. Changes to benefit elections

(a)   A participant may change an election only in accordance with the provisions of this Plan. This Section does not remove the requirement that every employee must enroll in at least the basic plan of coverage except for those employees declining participation pursuant to 260:40-17-3(c)(1).

(b)   All requests for changes submitted to the Plan Administrator must be in a format as determined by the Plan Administrator.

(c)   Provided that all other eligibility requirements are met, and written or electronic notice is provided to the Plan Administrator within thirty (30) days of a qualifying event, including receipt of a Qualified Medical Child Support Order, the effective date of such change of benefits coverage will be the first of the month following receipt of acceptable notice as determined by the Plan Administrator as long as the correct premium is paid. All enrollments and elections are for the entire Plan Year and are irrevocable during same Plan Year unless a change is requested based on one of the following permitted exceptions to the irrevocability rule. A change must comply with the IRS consistency rule as found in Treasury Regulations 1.125-4 as may be amended. Only the permitted exceptions provided for in this chapter shall be allowed as changes to benefits elections unless those changes are prohibited under the Premium Conversion Option, the Dependent Care Reimbursement Account Option or the Health Care Reimbursement Account Option as provided for in subchapters 23, 25, and 27 respectively. All changes shall become effective on a prospective basis and not earlier than the first day of the month following receipt of acceptable notice of the requested change which must be on account of and corresponding with the event with the exception of termination of coverage for a spouse and/or dependents who have ceased to satisfy eligibility as a result of death, which shall become effective the first of the month following the date of the event. Permitted exceptions to the irrevocability rule as allowed within Plan guidelines are as follows:

(1)   HIPAA Special Enrollment Rights (marriage, birth, adoption or placement for adoption, loss of other coverage including exhaustion of COBRA coverage)

(2)   Change in Employee's Legal Marital Status

(3)   Change in the Number of Employee's Dependents

(4)   Change in Employment Status of Employee, Spouse or Dependent that affects eligibility

(5)   Event Causing Employee's Dependent to satisfy or cease to satisfy Eligibility Requirements

(6)   Change in Place of Residence of Employee, Spouse or Dependent

(7)   Commencement or Termination of Adoption Proceedings

(8)   Judgments, Decrees or Orders (changes allowed only to Health, Health Care Reimbursement Account and Dental)

(9)   Medicare or Medicaid (changes allowed only to Health and Health Care Reimbursement Account)

(10)   Significant Change in Cost or a Change in Coverage (changes allowed only to Dependent Care Reimbursement Account)

(11)   Changes in Coverage of Spouse or Dependent under Other Employer's Plan

(12)   FMLA Leave

(13)   Such other events, which may permit such modification or election under the IRS consistency rule as found in Treasury Regulations 1.125-4 and in accordance with other applicable and prevailing Internal Revenue Code regulations promulgated thereunder, and in accordance with this chapter.

(d)   The following are the only permitted exceptions that may become effective on a retroactive basis beginning the first day of the event month. Such events require receipt of acceptable notice by the Plan Administrator or its designee within thirty (30) days of the event:

(1)   Newborn children who may be covered from the first of the birth month provided the proper documentation is submitted within thirty (30) days of the birth event and provided that the full monthly premium is paid.

(2)   Adopted eligible dependent children, those placed for adoption, and eligible children for whom guardianship has been newly granted to the insured or to the insured's spouse and for whom coverage may begin from the first day of physical custody even though a full month's premium must be paid; or at the insured's option may be covered beginning the first of the month following placement.

(e)   The Plan Administrator reserves the right to make any corrections necessary if an error was made regarding the effective date.

[Source: Added at 31 Ok Reg 1358, eff 9-12-14]