IQVIA Benefits Handbook
MAKING MID-YEAR ENROLLMENT CHANGES
The coverage you elect under the IQVIA Health Care Plan will remain in effect from January 1 (or the date you began participation) through December 31. Generally, you can make changes only during the open enrollment period. However, because your needs may change when you experience certain life events, you may be allowed to make mid-year enrollment changes in certain situations in accordance with the Internal Revenue Code and as permitted by the plan administrator.
Life Status Change
A life status change (also known as a "qualified status change") is an event that may allow you to make certain mid-year changes to your health care coverage. Changes to your health care coverage must be consistent with the change in status. Generally, the event must affect your eligibility, your eligible spouse's eligibility or your eligible dependent child's eligibility for coverage under an employer plan (including plans of other employers). Under the IQVIA Health Care Plan, life status changes include:
  • Marriage or divorce.
  • Birth or adoption of a child.
  • A child ceases to be an eligible dependent.
  • You or your spouse gains or loses group coverage.
  • A change in your employment status (including a reduction in hours), or the employment status of your spouse or dependent, which affects plan eligibility.
  • Death of your spouse or child.
  • You or your spouse takes an unpaid leave of absence pursuant to the Family and Medical Leave Act.
  • Reduction in hours of service—you and your dependents may drop your group health plan coverage, even if you remain eligible for such coverage, if:
    • You were reasonably expected to work 30 hours per week and you experience a change in employment, after which you are reasonably expected to work less than 30 hours per week
    • You intend to enroll yourself and any dependents dropping coverage in another health plan (satisfying the Affordable Care Act's definition of minimum essential coverage) effective no later than the first day of the second month after you drop IQVIA Health Care Plan coverage.
  • Enrollment in a health plan offered through the public Marketplace—If you are eligible for a special enrollment period to enroll in public Marketplace coverage, or you want to enroll in public Marketplace coverage during the public Marketplace's annual open enrollment period, you may drop group healthcare coverage under the IQVIA Health Care Plan, even if you remain eligible for coverage under this Plan. You (and any dependents whose coverage is dropped at this time) must intend to enroll in Marketplace coverage that is effective no later than the day immediately following the last day your coverage under the IQVIA Health Care Plan is dropped.
All changes must be consistent with the life status change. For example, if you have a change due to the birth of a child, you may add that child to your coverage, but you cannot remove another family member.
Network Provider Changes Are Not Life Status Changes
The enrollment choices you make are in effect for the entire calendar year in which you enroll. Changes in your plan's network coverage are not considered to be a life status change. For example, if your doctor is no longer available through the network, you cannot change your coverage until the next open enrollment period as this wouldn't be considered a life status change.
You also may be able to change your benefit elections because of certain other events:
  • A special enrollment right under the Health Insurance Portability and Accountability Act of 1996 (HIPAA).
  • A judgment, decree or qualified medical child support order (QMCSO) requiring coverage for a child.
  • Eligibility for Medicare or Medicaid.
  • Certain leaves under the Family and Medical Leave Act (FMLA).
  • Significant cost or coverage changes.
Special Enrollment Rights
Under the Health Insurance Portability and Accountability Act of 1996 (HIPAA), you have special enrollment rights under certain circumstances. If you're declining enrollment for yourself or your eligible dependents (including your spouse) because of other health insurance coverage and that coverage ends, you may enroll yourself or your eligible dependents in the IQVIA Health Care Plan provided that you request enrollment within 30 days after your other coverage ends.
If you or your eligible dependents were eligible for IQVIA health care coverage but declined because you had other health insurance coverage, you may enroll in the IQVIA plan if you lose coverage under the other plan because:
  • Your eligibility ends.
  • Your COBRA coverage is exhausted.
  • Employer contributions to the other coverage end.
In addition, if you have a new dependent as the result of a marriage, birth, adoption or placement for adoption, you may enroll your dependents, provided that you request enrollment within 30 days after the marriage, birth, adoption or placement for adoption. Coverage for the new dependent child will be effective from the date of birth, adoption or placement for adoption. However, if you miss the 30-day deadline, you'll have to wait until the next open enrollment period (or for a life status change or another special enrollment right) to enroll.
Please Note: Newborns aren't automatically covered by the plan; you must enroll all dependents for coverage.
Children's Health Insurance Program (CHIP) or Medicaid
You have a special enrollment opportunity if you or your eligible dependents either:
  • Lose Medicaid or Children's Health Insurance Program (CHIP) coverage because you are no longer eligible.
  • Become eligible for your state's premium assistance program under Medicaid or Children's Health Insurance Program (CHIP).
For these enrollment opportunities, you will have 60 days (instead of 30 days) from the date of the Medicaid/CHIP eligibility change to request enrollment in the IQVIA Health Care Plan. This two-month notice deadline does not apply to enrollment opportunities other than the Medicaid/CHIP eligibility change.
Judgments, Decrees and Orders
You may make a change that corresponds to any judgment, decree or order requiring the Medical Plan to provide medical coverage to your dependent child. In the case of a child whom you're required to cover pursuant to a qualified medical child support order (QMCSO), coverage will begin on the date specified in the order, or if none is specified, the date the order is received. You may decrease your coverage for that child if the court order requires the child's other parent to provide coverage and your spouse's or former spouse's plan actually provides that coverage. (For more information on what you should do if you or IQVIA receives a QMCSO, call the IQVIA Benefits Marketplace at 888-264-9180.)
Medicare or Medicaid Entitlement
You may change an election for medical coverage mid-year if you, your spouse or your eligible dependent becomes entitled to (or loses entitlement to) coverage under Part A or Part B of Medicare, or under Medicaid. However, you're limited to reducing your medical coverage only for the person who becomes entitled to Medicare or Medicaid, and you're limited to adding medical coverage only for the person who loses eligibility for Medicare or Medicaid.
Family and Medical Leave Act (FMLA)
You may drop medical coverage mid-year when you begin an approved unpaid leave that satisfies the provisions of the Family and Medical Leave Act (FMLA).
When you return from an FMLA leave, you will be immediately reinstated in the same elections you made before taking your FMLA leave. See "If You Go Out on Leave" for more information.
Significant Cost or Coverage Changes
If the cost of benefits increases or decreases during a benefit period, IQVIA may, in accordance with plan terms, automatically change your elective contribution. When the change in cost is significant, you may either increase your contribution or elect less-costly coverage.
In addition, you may make changes to your elections if:
  • There is a significant overall reduction to your benefit option.
  • Your coverage option ceases.
  • A new coverage option is added.
How to Make Changes
Changes Must Be Consistent with Your Life Status Change
Keep in mind that most of the changes you make to your coverage must be consistent with the change in your status.
You have 30 days from the date of the following events to enroll in or make a coverage change:
  • Life status change.
  • Judgment, decree or order.
  • Change in Medicare or Medicaid entitlement.
  • Significant cost or coverage changes.
If you don't make changes within this 30-day period, you can't enroll for coverage until the next open enrollment period.
You have 30 days from the date you experience an event under the HIPAA special enrollment rights provision to enroll in or change your coverage. If you don't make changes within the 30-day period, you can't enroll for coverage until the next open enrollment period. You can make a change to your coverage at the IQVIA Benefits Marketplace website.