1. Can I change from one plan to another during the year?

Yes, but only if you, the employee, experience one of the following events and file a health benefits application within 30 days. Coverage will then be 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 change in residence. You may again change plans when you return for 3 months by submitting another application within 30 days before or after your return. For more information, see Question below: 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. The expiration of COBRA permits you to enroll, but if you lose COBRA due to non-payment of premium, that does not permit you to enroll.
  • 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, grad, and local 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 enrolled in other group coverage (not for example, Medicare) 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 anytime.
  • Retirees and Survivors only: If you or a dependent newly enroll in Medicare Parts A and/or B, you may change health plans. You may enroll when you’re first eligible to sign up for Medicare Part A and Part B, generally starting 3 months before you turn 65, the month you turn 65, and ending 3 months after the month you turn 65. Your current coverage might not pay for health services if you don’t have both Part A and Part B. You should submit your application to ETF prior to your Medicare effective date, and it can be sent up to 3 months in advance of the change. This will mean that your new plan will be effective at the same time as Medicare. You may also submit the application during your birth month, and up to 90 days after your Medicare effective date but if you do, your new plan will begin the first of the month following receipt by ETF. 

Note: If your premiums are being deducted post-tax, you may cancel coverage anytime. If your premiums are being deducted on a pre-tax basis, you may cancel coverage mid-year only if you become eligible for and enroll in other group coverage (not for example, Medicare) 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.

See the Life Events Guide for more information.

2. If I change plans what happens to any out-of-pocket 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 out-of-pocket 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. If you are enrolled in the Uniform Dental Benefit you will continue accumulating to the same benefit maximums.

If you do not change health plans but move between two options offered by the same health plan mid-year your benefit maximums and out-of-pocket limits will continue to accumulate. For example, changing from individual to family coverage, or if you or your spouse change to become the subscriber.

3. What if I have a temporary or permanent move from the service area?

If you move out of a service area (for example, out of the county), either permanently or temporarily for three months or more, you will be permitted to enroll in the Access Plan or another Health Plan that offers in-network providers near you, Employees should make this change with their employer. Retirees should submit a paper application to ETF. The submission must be sent within 30 days before or 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, but for longer than three months, you may again change plans by submitting an application within 30 days before or after your return.

You must submit your application to change plans 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 (by ETF for retirees), 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. For more information, see Enrolling for Coverage FAQs Question: Are there other enrollment opportunities available to me after my initial one expires?

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, or 12 months have passed. 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 is responsible for determining whether a newly enrolled disabled dependent continues to meet the contractual definition of a disabled dependent or not. For more information, see Dependent Information FAQs Question: What if I have an adult child who is, or who becomes physically or mentally disabled?