Qualifying Events for the SHI Benefits Plan
What is a Qualifying Event?
A Qualifying Event (sometimes called a Life Event) is a life change that may allow you to add or remove insurance coverage for you or your dependents outside of regular enrollment periods. Most insurance carriers including SHI, require you to provide documentation of the event. Reaching the age limit of an existing plan, gaining a new spouse or child, or new coverage through a new employer are common qualifying events.
The following are NOT Qualifying Events for Student Health Insurance:
An "Open Enrollment" period for an insurance policy. Newly selecting employer coverage or marketplace coverage during an Open Enrollment period is not a Qualifying Event.
The loss of a university subsidy or a change in personal financial circumstance.
Purchasing other health insurance after the Select/Waive deadline of your first term in an academic year.
How to request a change due to a Qualifying Event:
Submit a Coverage Status Change Form within 31 days of the date of the Qualifying Event. Forms submitted past 31 days will not be processed. If you are unsure what date is your Qualifying Event date, please contact us ahead of time to clarify so you may plan accordingly and not miss your deadline.
List of Qualifying Events:
Documentation is required when submitting your request. Please see the Coverage Status Change form for details.
To ADD SHI Benefits Plan Coverage when you currently have a Waiver:
- You reached the AGE LIMIT of your other coverage.
- Because of a JOB LOSS, you lost your coverage involuntarily.
- Because of a DIVORCE, you lost your coverage involuntarily.
- You attained eligibility after the 2nd Friday of the academic term.
- You experienced other involuntary loss of coverage.
To ADD Dependents to your existing SHI Benefits Plan Coverage*:
- You have a NEWBORN OR NEWLY ADOPTED CHILD.
- You have a NEW SPOUSE.
- You have a new DOMESTIC PARTNER.
- You have a dependent(s) who newly arrived in U.S. from their foreign homeland.
- You are assigned new responsibility to insure your dependent(s).
*If you currently have a waiver, a new dependent is not a Qualifying Event.
To TERMINATE SHI Benefits Plan Coverage for You and/or Your Dependent:
- You/your family has a NEW JOB/POSITION with new eligibility for an employer insurance plan. Note: You must contact our office within 31 days of the hire/new eligibility date and submit proof that you are now enrolled under the new employer insurance as of the date of the qualifying event, regardless of when your employer-sponsored health insurance will begin.
- You have new eligibility for a new insurance plan through a NEW SPOUSE.
- You have new eligibility for a new insurance plan through a NEW DOMESTIC PARTNER.
- Because of a DIVORCE, you need to remove your dependent(s).
- Because of a termination of Domestic Partnership, you need to remove your dependent(s).
- Your dependent(s) returned to their foreign homeland.
- You received notification of retroactively awarded Medicaid eligibility. NOTE: You must have applied for Medicaid prior to your first Select/Waive deadline of the academic year. See the section below for more details.
Approval Process and Effective Dates for Changes
Requests are approved based on compliance with the 31-day deadline and the submission of documentation that verifies the event occurred.
If you are adding SHI coverage, it will begin the date your other coverage involuntarily ended and a prorated fee will post to your University Statement of Account. Fees must be paid in full in order to use the benefits.
If you are terminating SHI coverage, termination will begin at the start of the coverage period subsequent to the period containing the Qualifying Event. No fee refunds will be issued for the coverage period containing your Qualifying Event. This means that if your Qualifying Event occurs in Spring/Summer -- for example, you get a new job with new insurance starting April 1 -- you cannot terminate until the following Autumn. Review coverage period and policy year dates here.
For students who applied for Medicaid prior to their first SHI Select/Waive deadline of the year:
We recognize students with pending Medicaid applications may select the SHI Benefits Plan while awaiting Medicaid notification. If a student is retroactively approved for Medicaid coverage and can document that they applied for Medicaid before the Select/Waive deadline of their initial coverage period of the academic year (for example, if the student initially meets insurance requirement eligibility in Autumn 2021 semester, they must document they applied for Medicaid before the Autumn Select/Waive deadline of 8/17/21), they can submit a Coverage Status Change request to retroactively change their selection to a waiver, per the following:
1) Students must submit the following to SHI within 31 days of when they received Medicaid notification:
- A completed Coverage Status Change Form
- A copy of the Medicaid Notice of Action Letter showing the date you applied and the date the issued coverage was effective
- A copy of your Medicaid Eligibility Portal screen shot
2) Students must have submitted their Medicaid application prior to the Select/Waive deadline of their initial coverage period. For example, if you meet insurance requirement eligibility in Autumn 2021 semester, you must have applied for Medicaid before the Autumn Select/Waive deadline of 8/17/21.
When items 1 and 2 above are met, approvals will be issued as follows:
- If the SHI Benefits Plan has not paid claims on behalf of the student or student’s covered dependents, the Waiver will be granted retroactively to the start of the initial coverage period.
- If the SHI Benefits Plan did pay claims on behalf of the student or covered dependents, the Waiver will be approved for the coverage period subsequent to the student’s initial coverage period. This may mean the student will retain both Medicaid and SHI Benefits Plan for a time period. Optional: If the student takes action to work with the SHI Benefits Plan Claims Administrator and their Medicaid Plan to resubmit the paid claims to Medicaid and reverse the SHI Benefits Plan payments, SHI can consider approving a Waiver for the initial coverage period.
Annual Selection Reminder
Outside of Qualifying Events, your Select/Waive choice at the start of your first term stays in effect for a standard period of time. If you select the SHI Benefits Plan, it is effective for the entire policy year and you cannot modify your choice term-to-term. If you waive the SHI Benefits Plan, the waiver will stay in place for the entire policy year; you can, if you wish, newly Select the SHI Benefits Plan for a subsequent coverage period within a policy year.