1. Can I change from one plan to another during the year?
Yes, but only if you, the subscriber, file a health benefits application within 30 days for the following events with coverage effective on the first day of the month on or following receipt of the application:
- Move from your plan's service area (for example, out of the county) for a period of at least 3 months. Your new coverage will be effective subsequent to your move. You may again change plans when you return for 3 months by submitting another application within 30 days after your return. (See Question: What if I have a temporary or permanent move from the service area?)
- You involuntarily lose eligibility for other coverage or lose the employer contribution for it.
- You add one or more dependents due to marriage.
- You add one or more dependents due to birth, adoption or placement for adoption. You have 60 days to make the change under this event.
- State and Grad only: If your premiums are being deducted on a pre-tax basis, you may cancel coverage mid-year only if you are cancelling because you have become eligible for and enroll in other group coverage or terminate employment. Otherwise, you can only change health plans without restriction during each annual open enrollment period and coverage will be effective the following January 1. If your premiums are being deducted post-tax, you may cancel coverage at anytime.
See the Life Change Event Guide for more information.
2. If I change plans, what happens to any benefit maximums that may apply to services I've received?
When you change health plans for any reason (for example, during an open enrollment period or for a move from a plan's service area), any annual health insurance benefit maximums under Uniform Benefits (such as durable medical equipment) will start over at $0 with your new plan, even if you change plans mid-year, with the exception of the prescription annual out-of-pocket maximum. You will continue accumulating to the same benefit maximums under the Uniform Dental Benefit plan as well.
If you move between two options offered by the same health plan carrier mid-year, your benefit maximums and out of pocket limits will continue to accumulate.
A subscriber who moves out of a service area (for example, out of the county), either permanently or temporarily for three months or more, will be permitted to enroll in the Access Plan or an available alternate plan offered under the IYC Health Plans that offers in-network providers near you, provided an application for such plan is submitted within 30 days after relocation. You will be required to document the fact that your application is being submitted due to a change of residence.
If your relocation is temporary, you may again change plans by submitting an application within 30 days after your return. The change will be effective on the first of the month on or after your application is received by your employer or by ETF, but not prior to your return.
State and Grad only: It is important that you submit your application to change coverage as soon as possible and no later than 30 days after the change of residence to maintain coverage for non-emergency services. The change in plans will be effective on the first day of the month on or after your application is received by your employer but not prior to the date of your move. If your application is received after the 30-day deadline, you will not be allowed to change plans until the following open enrollment period or in certain situations.
4. What if I change plans but am hospitalized before the date the new coverage becomes effective and am confined as an inpatient on the date the change occurs (such as January 1)?
If you are confined as an inpatient (in a hospital, a skilled nursing facility or, in some cases, an Alcohol and Other Drug Abuse (AODA) residential center) or require 24-hour home care on the effective date of coverage with the new plan, you will begin to receive benefits from your new plan unless the facility you are confined in is not in your new plan's network. If you are confined in such a facility, your claims will continue to be processed by your prior plan as provided by contract until that confinement ends and you are discharged from the non-network hospital or other facility, twelve months have passed or the contract maximum is reached. If you are transferred or discharged to another facility for continued treatment of the same or related condition, it is considered one confinement.
In all other instances, the new plan assumes liability immediately on the effective date of your coverage, such as January 1.
5. What if I have an adult child who is disabled and I am changing health plans during open enrollment?
Each health plan has the responsibility to determine whether or not a newly enrolled disabled dependent continues to meet the contractual definition of disabled dependent. (See the Dependent Information section of this FAQ.)