Other Life Events
Life Event (Qualifying Event)
Timeframe to Submit Documentation
Effective Date
Documentation Required
Change in Employment Status
FCPS employee that becomes eligible to enroll in benefits due to a change in hours or change in position:
May enroll in coverage
- HR-124 (Current employees) or HR-461 (Retirees)
- Letter from employer documenting change in status and effective date; open enrollment notice from employer with enrollment and effective dates; documentation from employer showing costs before and after plan change and effective date.
- Supporting documents based on the dependent(s) being enrolled. See Dependent Eligibility chart.
Gain or Loss of Health Coverage of existing health coverage, including job-based, individual, and student plans:
May enroll or cancel coverage
- HR-124 (Current employees) or HR-461 (Retirees)
- Letter from employer documenting change in status and effective date; open enrollment notice from employer with enrollment and effective dates; documentation from employer showing costs before and after plan change and effective date.
- Supporting documents based on the dependent(s) being enrolled. See Dependent Eligibility chart.
Newly hired to FCPS in a full-time or part-time authorized position:
May enroll in coverage
- Onboarding completion
- Supporting documents based on the dependent(s) being enrolled. See Dependent Eligibility chart.
- HR-124 (Current employees) or HR-461 (Retirees)
- Photocopy of the death certificate
- Supporting documents based on the dependent(s) being enrolled. See Dependent Eligibility chart.
Gain or Loss of Medicare, Medicaid, or CHIP eligibility:
May enroll or cancel coverage
- HR-124 (Current employees) or HR-461 (Retirees)
- Attach letter from Medicare/Medicaid showing date entitled (or lost) eligibility.
- Supporting documents based on the dependent(s) being enrolled. See Dependent Eligibility chart.
- HR-124 (Current employees) or HR-461 (Retirees)
- Letter from plan administrator documenting loss/expiration of COBRA coverage and effective date.
- Supporting documents based on the dependent(s) being enrolled. See Dependent Eligibility chart.
If you think you might be experiencing a Life Event (Qualifying Event) that is not listed in the chart above, please contact the Office of Benefit Services by using FCPS StaffConnect or by calling 571-423-3200 , option 3.