Qualifying Life Events (QLE)

Mid-Year Benefit Changes

You may add or cancel coverage during the plan year if you have a change in family status.

You cannot change your benefit elections for the plan year unless Human Resources receives notification in writing within 30 days of the status change. If Human Resources is not notified within 30 days of the status change, no benefit change can be made until the next annual open enrollment.

IRS specified changes in family status include:

  • Change in legal married status

  • Change in number of dependents

  • Termination or commencement of employment

  • Dependent satisfies or ceases to satisfy dependent eligibility requirements

  • Change in residence or worksite that affects eligibility for coverage

You will need to call the benefit enrollment center, 866-343-0646,
and call your Human Resources.

Click the button below to open and download the form

 

Please return to HR upon completion of form.

If you cannot fill it out online, please contact HR to receive a copy.
By email at hr@co.guadalupe.tx.us or by phone at 830-303-8862