1. What is a Qualified Midyear Change?

Some life events qualify for changes in your plan choices and coverage levels after the start of the plan year and/or for new hires, after the initial new hire enrollment period. These are often referred to as Qualifying Status Changes (QSC).   Examples of Qualified Status Changes include:

  • Qualified Status Changes
    • Legal marital status change – marriage, divorce, or death of spouse
    • Change in Domestic Partnership relationship – gain or loss of a domestic partner
    • Number of dependents – birth, adoption, or death
    • Eligibility of dependent – dependent loses other group coverage
    • Change in residence (yours and/or a dependents) which results in a loss of plan eligibility (moving out of the service area)
  • Changes in cost or coverage
    • An increase in premium cost that you pay
    • Reduction in your spouse/domestic partner’s group health insurance plan benefits
    • Gain of other employer group coverage (you become eligible under a spouse/domestic partner’s plan)
    • A reduction or loss of other employer group coverage
  • Changes by law or court order
    • National Support Order Notice
    • HIPAA
  • Changes that affect eligibility for dependent care flexible spending account (FSA) include
    • You marry and gain children as dependents
    • Your spouse dies or you divorce or have a legal separation or annulment and this affects the need for dependent care
    • Your biological child is born, you adopt a child, or a child is placed with you for adoption
    • A dependent child dies
    • A child become eligible as a dependent for coverage under your benefits

2. Time frame for making benefit changes because of a Qualified Status Change (QSC)

You have 30 days from the “event date”  (i.e., birth, marriage) to make changes to your plan elections.  You must complete and submit the applicable change forms to the benefits office within 30 days of the qualifying event.

3. Making changes to health and optional insurances* – Forms

Complete and submit the appropriate forms within 30 days of the qualifying event. 

Based on the event, you may need to submit several forms (i.e., adding a grandchild by affidavit).  The applicable change forms are located on the PEBB Forms webpage under the following sections:

  • Midyear Change:  Includes the Midyear Change form for medical/dental and optional insurances, mid-year Tobacco-use Change, and Flexible Spending Accounts forms.
  • Covering Others:  Includes the Affidavit of Domestic Partner, Grandchild by Affidavit, etc.

Return completed form(s) to Employee Benefits:

    • Campus mail: 204 Kerr Administration Building
    • US mail: 122 Kerr Administration Building, Corvallis OR 97331-2132
    • Fax: 541-737-0553

*When adding a new spouse or domestic partner, you can enroll in the Optional Spouse/Partner Life Insurance and get the guaranteed issue amount of $20,000 without having to complete a health history statement and/or blood work.  Any amount above the guaranteed issue amount would require the health history statement and possible blood work.

4. Effective date of changes

Changes to coverage goes into effect the first of the month following receipt of the midyear change forms, except for:

  • Birth of a newborn or adoption of a child, coverage effective date will be retroactive back to the date of the birth or date of adoption
  • If the plan requires review of medical history before approving or denying coverage the coverage will go into effect the first of the month after approval by the plan (Optional Life, Optional Spouse/Partner Life, and Long-term Care insurance).

5. Tobacco Use Program – Status Change

Your status in the Tobacco-use Program may change during the year. For example, you or your spouse/domestic partner may quit using tobacco, or a medical provider could advise you not to try to quit using tobacco. These changes allow you to end the related monthly deduction for tobacco use.

Submit the Tobacco-use Program Midyear Change form to Employee Benefits within 30 days.

If the form is received by the 15th of the month, it will be processed in that month's payroll and the deduction will end with the start of the following month. If the form is received after the 15th of the month, it will be processed in the next month's payroll, and the deduction will end with the start of the month that follows.

6. Additional Resources