Status Changes - Workterra Qualifying Events

Under IRS rule, pre-tax benefit elections are irrevocable during a plan year and may only be changed if certain qualifying events occur that create a change in status. So long at the requested election change is consistent* with the qualifying event, you may enroll in, waive, or make changes** to the following benefits within 31 days of a qualifying event:

  • Medical/prescription
  • Dental
  • Vision
  • Flexible spending accounts (FSA)
  • Dependent care spending accounts (DCSA)
  • Life insurance*** (subject to evidence of insurability)
  • Legal services***

If you experience a status change you must initiate a qualifying event transaction in Workterra and submit supporting documentation within 31 days of the qualifying event’s occurrence. Qualifying event transaction requests made outside the 31-day window will be denied.

Effective Date of Status Change Elections

For elections based on birth/adoption or a return from an unpaid leave of absence, coverage is effective as of the qualifying event date.

For elections based on all other qualifying events, coverage is always effective on a prospective basis as of the first day of the next pay period following the qualifying event date. If you submit your qualifying event in Workterra in advance of the qualifying event date and would like the effective date to be adjusted to eliminate any gap in coverage, please email your request to doa.enrollmenthelp@hr.ri.gov and your effective date will be adjusted. Retroactive effective date adjustments are not allowed.

* An election change is consistent with a qualifying event if the change is on account of and corresponds with the event.

** You may NOT make changes at the PLAN level for a coverage that you had already enrolled in. Example: If you had enrolled in Anchor Plus, so long as your qualifying event is consistent with your requested change, you may waive coverage or switch from single coverage to family coverage and vice versa, but you may NOT switch to Anchor or Anchor Choice.

*** These benefits are subject to status change rules even though some or all of their premiums are deducted from your pay on a post-tax basis.

What's Considered a Qualifying Event?

There are many different kinds of qualifying events, but generally anything that affects an employee’s or dependent’s eligibility for coverage under a plan would qualify. Here are some examples:

  • Marriage
  • Divorce
  • Death
  • Birth
  • Adoption
  • Employee turning 26 and losing coverage under parent's plan
  • Certain family relations orders/decrees
  • Family member entering the US under a visa
  • Change from full-time to part-time employment or vice versa for you or your dependent
  • Commencement or return from an unpaid leave of absence for you or your dependent
  • Employment begins or ends, or open enrollment period for your dependent
  • Loss/gain of coverage under another plan for you or your dependent
  • Commencement or return from military leave for you
  • Commencement/cessation of military service for your dependent

When you experience one of the above qualifying status change events, you will have 31 days to make adjustments to/drop your benefits coverage. If you do not, will have to wait for the next open enrollment period to adjust your benefits elections unless you experience another qualifying status change event first.

Also, if your qualifying status change event is the commencement of an unpaid leave of absence or military leave and you do not drop your benefits coverage and elect the medical waiver opt-out payment within 31 days of that leave period beginning, you will remain responsible for your contributions towards the cost of your health coverage and you will not be able to elect the medical waiver opt-out payment for the duration of your leave period. Please refer to the Leave Without Pay (LWOP) Employees page for additional details related to the health coverage billing process for employees on leave without pay.

How Do I Make a Status Change Election?

If you are commencing or returning from an unpaid leave of absence

Please email doa.enrollmenthelp@hr.ri.gov for assistance on processing your benefit elections.

All other qualifying events

To process a status change and enroll in or make changes to your coverage, you will use the State’s online enrollment system, Workterra. Please make sure you first have the required supporting documentation evidencing your status change event and date, and consider calling the Office of Employee Benefits or emailing doa.enrollmenthelp@hr.ri.gov for guidance and tips in advance of processing your status change in Workterra.

  • A copy of the marriage certificate
  • A copy of the final divorce decree
  • A copy of the death certificate or obituary
  • A copy of the birth certificate. (We understand that this takes time. Please add your newborn as a dependent within 31 days of date of birth and follow up with the birth certificate once received; same for the social security number.)
  • A copy of the adoption decree
  • A HIPAA letter from the other carrier, or
  • A COBRA letter that shows coverage is being offered due to a loss of coverage elsewhere
  • A letter from the other employer’s HR office proving a loss/gain of coverage, or
  • A HIPAA letter from the other carrier, or
  • A COBRA letter that shows coverage is being offered due to a loss of coverage elsewhere
  • A copy of the relevant court order/decree
  • A copy of the visa (or other official document supporting entry into the US). (We understand that it takes time for your family member to obtain their social security number. Please add your family member within 31 days of their entrance and follow up with their social security number once received.)
  • If a State employee
    • A copy of the CS3
  • If not a State employee
    • A letter from the other employer's HR office proving a loss of coverage due to the employee no longer being eligible
  • If a State employee
    • A notification from HR stating that the employee is going on leave or returning from leave
  • If not a State employee
    • A letter from the other employer's HR office proving a loss of coverage due to a leave, or a gain of other coverage due to a return
  • A letter from the other employer’s HR office proving a start of employment, a termination of employment, or open enrollment
  • Copy of military orders/discharge paperwork