Choice Stories

June 18, 2022

When Employees Can Make Health Plan Changes

Making changes to your health insurance coverage isn't limited to your annual open enrollment. If you experience what the Affordable Care Act (ACA) calls a "life event," you and your employees can also make changes to your coverage.

What Is a Life Event?

There are several different “triggers” that could make your employees eligible to change their coverage, including:

  • Marriage or domestic partnership: A change in an employee’s marital status (e.g., divorce or separation) or domestic partnership.
  • New family member: Adding a dependent child through adoption or birth.
  • Late enrollment or involuntary loss of coverage: If an employee previously waived coverage (and did not enroll when first eligible because of other coverage), he/she/they can enroll late and/or change benefits if that other coverage ends due to death of the spouse (who maintained it) or loss of eligibility for benefits due to reduced work hours or job loss.
  • Remove coverage or dependents: A covered employee can remove existing insurance or dependents from his/her/their CaliforniaChoice coverage. For example, when a dependent child reaches age 26.
  • Moving: If an employee moves to a new place of residence (and out of the existing health plan’s service area), that qualifies, too.

When Can I Make Changes to my Group Health Plan?

Making Coverage Changes

Employees have a limited window – 60 days from a qualifying/triggering event – to make changes.

At CaliforniaChoice, we want to make these changes easy for members. If an employee wants to add coverage for a newborn or newly adopted child or remove a dependent from coverage, they simply take the following steps:

  • Visit calchoice.com, click on “Life Events” and then “New Family Member” or “Remove Coverage or Dependents” to submit a Change Request online.
  • Download, complete, and submit a Change Request Form, along with proof of adoption or a newborn) to the group contact. Or, send it via email to the CaliforniaChoice Customer Services team.

Effective Date of Changes

Changes requested will be effective on the first day of the month following receipt of a completed request. For example, if an employee submits a request/application on May 10, the change would be effective on the first of June. (If the employee submits a request through you, it’s important you forward it to CaliforniaChoice as soon as possible, so as not to delay the effective date.)

If new ID Cards are issued in connection with the request, they will be sent within 7-10 business days after the processing is complete.

Help When You or Your Employees Need It

While there are many actions you and your employees can take online concerning your bill, account changes, coverage, and benefits, the CaliforniaChoice team is available to offer support by email or phone. Our Customer Service team is available Monday through Friday, 8:00 a.m. to 5:00 p.m., Pacific Time.

Your Beginner's Guide to Choosing a Small Business Employee Benefits Program

Do you need help choosing the right health benefits for your employees?
This guide can help!