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Qualifying Life Events & Eligibility for ASRS Medical or Dental Insurance

What is a Qualifying Life Event?

A qualifying life event allows you the opportunity to enroll and/or make changes to existing coverage for yourself or your dependents outside of the annual Open Enrollment period.

You must make these changes no later than 31 calendar days from the date the qualifying event took place, unless a different deadline is indicated for a specific qualifying life event.

The following are the Qualifying Life Events recognized by the ASRS for enrollment and/or changes to your existing coverage outside of the annual Open Enrollment period. ASRS has the sole discretion to determine whether a Qualifying Life Event has occurred and whether your situation allows you to enroll or make changes to existing coverage.

Coverage Eligibility

ASRS provides the opportunity for its members to enroll in the plan, but there are eligibility restrictions for individuals enrolled in other health plans. This is known as “dual enrollment.” It is important that you understand those limitations as it may affect your (and your dependents’) eligibility to enroll in or remain enrolled in ASRS health plans. Individuals who are ASRS retirees, disabled ASRS members, surviving dependents of ASRS members, and their dependents may not be enrolled in the ASRS health plan at the same time they are enrolled in another group health and accident plan or program.

Similarly, retired members of the Public Safety Personnel Retirement System (PSPRS), the Elected Officials’ Retirement System (EORP DB Plan or EORP DC Plan), the Correction Officer Retirement Plan (CORP), the University Optional Retirement Plan (UORP), or other retirement plans that might be offered by the community college districts, and their dependents may not be enrolled in an ASRS health plan while also enrolled in a health plan offered by the Arizona Department of Administration.

Some members may have more than one source of eligibility, however, individuals are limited to one enrollment at a time. For example, you may be eligible to enroll in a plan due to your participation in the ASRS and another eligible retirement plan, but you may only be enrolled in a plan in one capacity at a time—either as a member or dependent.

Additionally, if you and your spouse are both eligible to enroll in a plan, you cannot enroll each other as dependents, nor have your children enrolled twice.

    • One spouse may elect coverage for the entire family, or each spouse may elect their own coverage.
    • Dependent children can be on one spouse’s policy or divided between spouses.

If ASRS determines a participant has prohibited dual coverage, enrollment in the ASRS Plan will be terminated and no refunds for any premiums you paid will be issued.

Retirement

New retirees are able to enroll and add dependent coverage in any plan they are eligible for at the time of their retirement. Supporting documentation will not be required, unless you wish to cover a dependent child over the age of 26.

Your insurance application must be submitted within 31 days of your retirement date. Coverage will be effective on the first day of the month following your retirement date. Health insurance premium deductions (retroactive to your coverage effective date) will not be deducted from your monthly pension payment until your retirement benefit has been finalized. Read more about retirement and health insurance premiums, as well as the premium benefit subsidy by visiting AzASRS.gov and selecting the "Retiree" tab.

Change in marital status

You may enroll in a plan, change plans, and/or add dependent coverage for new dependents resulting from a new marriage, including the spouse, even if you declined to enroll in a plan during the previous Open Enrollment Period.

If the change in marital status results in the loss of other coverage (for example due to divorce, legal separation, annulment, or the death of a spouse), you and your dependents may enroll in a plan or change plans. You may (and must in the case of a spouse) also remove a dependent due to a change in marital status such as divorce, legal separation, annulment, or death of a spouse. You will be asked to provide documentation that supports the occurrence of this qualifying life event.

Your enrollment application must be submitted within 31 days of the date of your qualifying life event. Coverage will be effective on the first day of the month after you submit your enrollment application.

Change in dependent status

You may enroll in a plan, change plans and/or add dependent coverage for new dependents resulting from a change in dependent status such as a birth or adoption, even if you declined to enroll in a plan during the previous Open Enrollment Period. In such cases, you may also add a dependent not previously covered.

You may also remove dependent coverage in the event of a change in dependent status. You will be asked to provide documentation that supports the occurrence of this qualifying life event.

Your enrollment application must be submitted within 31 days of the date of your qualifying life event. Coverage will be effective on the first day of the month after you submit your enrollment application for coverage.

Change Relating to Medicaid or Children's Health Insurance Program (CHIP)

If you or your dependents become eligible for a Medicaid or CHIP subsidy or lose coverage under Medicaid or CHIP, you may enroll in a plan, change plans, and/or add or remove dependent coverage. Supporting documentation will be required.

Your enrollment application can be submitted within 60 days of the date you or your dependent is determined to be eligible for the subsidy or the date coverage is terminated. Coverage will be effective on the first day of the month after you submit your enrollment application.

Change in primary residence

You may change plans, and/or add or remove dependents if you have a change in your place of residence affecting your current coverage through ASRS. Your address on file with the ASRS must correspond to the coverage area in which you are enrolling (Arizona or nationwide).

Your enrollment application must be submitted within 31 days of the date of your qualifying life event. Coverage will be effective on the first day of the month after you submit your enrollment application for coverage.

Change in Medicare eligibility

You may enroll in a Medicare medical plan when you become Medicare eligible. If you and/or your dependent are already enrolled in non-Medicare medical coverage through the ASRS, you and/or your dependent must switch to a Medicare plan upon becoming Medicare eligible. Failure to enroll in a Medicare plan will result in the termination of coverage for you and/or your dependent. If this occurs, you may not be able to re-enroll in an ASRS medical plan unless you have a Qualifying Life Event or until the next Open Enrollment Period.

Please note: Medicare eligibility is NOT a Qualifying Life Event for dental plans - only for medical plans.

Your enrollment application can be submitted 90 days prior to your Medicare eligibility date. Coverage will be effective on the first day of the month you become Medicare eligible.

If you are already enrolled in a Medicare Advantage plan you may be able to make changes to your plan outside of the annual Open Enrollment Period in other special circumstances. Please refer to Medicare.gov for more information regarding special circumstances.

You can also speak with a Medicare specialist by calling (800) 432-4040 if you reside in Arizona, or you can check the Medicare.gov website for contact information if you reside outside of Arizona.

Loss of other coverage (spouse, employer, COBRA)

You may enroll in a plan, change plans and/or add dependent coverage when:

    • you or your dependent has lost group or individual health insurance coverage due to a loss of eligibility for the coverage (including termination of employment or reduction in hours, but not including a failure to pay premiums or voluntary termination of coverage),
    • the group medical plan option in which you or your dependent are enrolled terminates or ends,
    • you or your dependent’s coverage under a non-calendar year plan ends at the end of that plan’s year and you or your dependent do not renew coverage under that plan, resulting in a loss of coverage.
    • the employer sponsoring the group medical plan in which you or your dependent are enrolled ceases making contributions towards the costs of coverage, or you or your dependent exhaust COBRA continuation coverage.

Please note: You will be asked to provide documentation that supports the qualifying life event. Voluntarily terminating your non-ASRS group or individual medical insurance plan is not a qualifying life event.

Your enrollment application must be submitted within 31 days of the date of your qualifying life event. Coverage will be effective on the first day of the month after you submit your enrollment application.

Long Term Disability

If you are approved for the ASRS Long Term Disability Program, you may enroll yourself and your dependents in any plan for which you are eligible. Supporting documentation will not be required, unless you wish to cover a dependent child over the age of 26.

Your enrollment application must be submitted within 31 days of your disability benefit effective date. Coverage will be effective on the first day of the month after you submit your enrollment application.

For more about ASRS Retiree Health Insurance, please refer to our section on Heathcare.

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