The following is a general description of the Commonwealth of Virginia’s State Health Benefits Program eligibility and enrollment information for employees. It is not intended to replace member handbooks and other plan documents. For more detailed information or clarification, visit the DHRM website at www.dhrm.virginia.gov or contact your Benefits Administrator. Participation in the State Health Benefits Program is subject to current program provisions, state and federal laws and regulations, and plan availability. The Commonwealth reserves the right to change your enrollment to ensure compliance.
When Can I Request Enrollment or Election Changes? When Newly Eligible
For health care coverage and flexible spending accounts, request enrollment within 30 calendar days of the date of hire
or of becoming eligible. The countdown begins on the day of the event. Once you have submitted a valid election during this enrollment window and that election takes effect, it is binding and may not be changed. When adding dependents to coverage, supporting documentation is required that provides proof of eligibility. If you do not have the documentation, do not miss the enrollment deadline. You have an additional 60 days from the election request to submit the eligibility documentation. Note: Health care coverage will not be effective until approved documentation is received. See your agency Benefits Administrator.
During Open Enrollment
The Open Enrollment period occurs each spring and is your annual opportunity to enroll or make election changes to health care coverage and to enroll in FSAs effective July 1. When adding dependents to coverage, supporting documentation is required that provides proof of eligibility. If you do not have the documentation, do not miss the enrollment deadline. You have an additional 60 days from the end of the Open Enrollment period to submit the eligibility documentation. Note: Health care coverage will not be effective until approved documentation is received. See your agency Benefits Administrator.
Qualifying Mid-Year Events (Life Events)
Certain qualifying mid-year events (life events) permit specific election changes outside the Open Enrollment period, including changes to your plan and membership. Examples of these events include changes in your employment, changes in your marital status, changes in the number of your eligible family members, and changes affecting the employment of a covered family member. Your change request must be received within 60 calendar days of the event and be on account of and consistent with the event. The countdown begins on the day of the event. Once you have submitted a valid election during this enrollment window and that election takes effect, it is binding and may not be changed. You will be asked to provide supporting documentation for the qualifying mid-year event (life event).
A complete list of qualifying mid-year events (life events) may be found on the DHRM website and on the attached enrollment form. When adding dependents to coverage, supporting documentation is required that provides proof of eligibility. If you do not have the documentation, do not miss the enrollment deadline. You have an additional 60 days from the election request to submit all the supporting documentation. Note: Health care coverage will not be effective until approved documentation is received. See your agency Benefits Administrator.
If you are declining enrollment for yourself or your dependents (including your spouse) because of other health insurance or group health plan coverage, under a HIPAA Special Enrollment you may be able to enroll yourself and your dependents in this plan if you or your dependents lose eligibility for that other coverage (or if the employer stops contributing towards your or your dependents’ other coverage). However, you must request enrollment within 60 days of the day your or your dependents’ other coverage ends (or after the employer stops contributing toward the other coverage). In addition, if you have a new dependent as a result of marriage, birth, adoption, or placement for adoption, you may be able to enroll yourself and your dependents. However, you must request enrollment within 60 days of the marriage, birth, adoption or placement for adoption.
The Children’s Health Insurance Program Reauthorization Act of 2009 (CHIPRA) created two new Special Enrollment rights for certain eligible employees and dependents who lose coverage or become eligible for premium assistance under a Medicaid or state children’s health insurance program. Employees must request coverage changes within 60 days of the eligibility determination.
To request a HIPAA Special Enrollment or obtain more information, contact your agency’s Benefits Administrator.
For more information, download "State Health Benefits Program : Active Employee Eligibility and Enrollment Form" on this page.