• - Your marriage, divorce (including annulment) or legal separation; also, the formation or dissolution of a domestic partnership.
• - Birth or adoption of a child; also, receipt of a Qualified Medical Child Support Order (QMCSO) requiring you to provide coverage for a dependent child.
• - Death of a dependent.
• - Your child reaching the maximum age for coverage (age 19, or age 25 if a full-time student); also, a change in your child’s student status.
• - You or your dependent become entitled to or lose eligibility for Medicare, Medicaid or COBRA coverage.
• - Any change in your or your dependent’s employment status that results in a change in benefits eligibility, such as:
• - Start or end of employment,
• - A change from full-time to part-time employment (or vice versa), or
• - Start or end of an unpaid leave of absence.
• - You or your dependent become eligible for, or lose, other health care coverage. (For information about your rights in the event of a loss of coverage, see “Your Special Enrollment Rights” later in this section.)
• - Your dependent changes his or her benefit elections during another company’s annual enrollment held at a different time than ACS’ annual enrollment.
• - A change in residence or worksite, either by you or your dependent, which affects the benefit plans that are available to you. Example: If you are enrolled in an HMO and move to a city in which that HMO is not available, you may change your medical option only; you may not change the family members covered.
• - A significant change in coverage or the cost of coverage under a benefit program provided through your or your dependent’s other employer. This does not apply to the health care spending account.
• - A change in your dependent care situation; for example, you change day care providers, the amount your provider charges changes or the amount of care that you require changes. In this case, you may only change your contribution to the dependent care spending account.

If you have a qualifying life status change and want to make a change in your elections, you must access BenefitsWeb and make the allowed change(s) within 31 days of the event. If you’ve had a baby or adopted a child, you must make the allowed changes within 60 days of the birth or adoption. However, if you are a member of an HMO you must make the allowed changes within 31 days of the birth or adoption. Services for a newborn/adopted child will not be covered until the child has been added through BenefitsWeb or through the ACS HR Workplace Solutions Center. After the child has been added, any eligible services will be covered back to the date of birth of the child or adoption date as long as the child was added within the required timeframe. Different rules may apply for HMOs or insured plans. Any benefits change you make must be directly related to and consistent with the status change. For example, if your child no longer qualifies as an eligible dependent, you may drop coverage for that child. However, you may not drop coverage for your spouse or domestic partner.

Be sure to print a copy of your Confirmation Statement for your records.

Please be aware that the IRS has issued very specific rules and restrictions for making changes as a result of a qualifying life status change. When making changes through BenefitsWeb, it is your responsibility to review these rules carefully and to ensure the changes you make comply with these rules. Misrepresenting or failing to timely report a change in status can result in disciplinary action, up to and including termination of your employment. In addition, you may be liable for claims paid on your and/or your dependents behalf, as well as civil action and reasonable attorney fees.

The options available to you as a result of your status change are based on IRS regulations and the Health Insurance Portability and Accountability Act of 1996 (HIPAA). Additional information about special enrollment rights that apply to individuals who previously declined health coverage, or added a dependent to their family is under “Your Special Enrollment Rights” below.

Special Enrollment Rights

To ensure individuals have access to health care coverage, Congress enacted HIPAA. Under the special enrollment provisions of HIPAA, you may be eligible to enroll in an ACS medical plan during the plan year, even if you previously declined coverage. This right extends to you and all eligible family members.

You will be eligible to enroll yourself (and any eligible dependents) in an ACS medical plan if:

• - You or your dependents have lost coverage under another plan because:
• - Employer contributions to the plan stopped (this will apply even if the covered individual continues receiving coverage under the prior plan by paying the amount previously paid by the employer);
• - There was a loss of eligibility due to divorce, legal separation, cessation of dependent status (e.g., reaching the maximum age to be eligible as a dependent under a plan), death, termination of employment, a reduction in hours to part-time status that affected benefits eligibility, the covered individual no longer lives or works in an HMO service area, the plan no longer offers benefits to a class of individuals that includes the previously covered individual; or
• - The covered individual incurs a claim that would exceed any lifetime limit on all benefits;
• - Your or your dependents’ COBRA coverage under another plan ends involuntarily; or.
• - The plan was terminated.
• - You gain a new dependent during the year as a result of marriage, birth, adoption or placement for adoption, or as a covered employee a court has ordered you to provide coverage for a dependent child as a result of a QMCSO.

This special enrollment right…

• - Will be extended to you only if you notify the ACS HR Workplace Solutions Center within 31 days of the event (for non-HMO medical plans, 60 days for the acquisition of a new dependent); and
• - Applies to medical coverage only. If you were not enrolled in the plan, you may enroll yourself and your eligible dependents in any medical plan option. If you are already enrolled in the plan and one of your dependents loses other coverage or you gain a new dependent, you may enroll your dependent in your current medical plan option or you may change your election and enroll yourself and your dependent in a different medical plan option.

Children’s Health Insurance Program Reauthorization Act of 2009 (CHIPRA)

Effective April 1, 2009, if you or your dependents lose coverage under Medicaid or the Children’s Health Insurance Program (CHIP) or you or your dependents become eligible for a premium assistance subsidy through these programs to pay for the cost of medical coverage, you may be able to enroll in one of the ACS medical options during the plan year, even if you previously declined coverage. This special enrollment right will be extended to you only if you notify the ACS HR Workplace Solutions Center within 60 days of the event.

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Questions about your employee benefits or other Human Resources issues? Contact the Workplace Solutions Center at (888) 471-2271.