Qualified Status Change

Employees may not change their benefit elections during the course of a plan year unless they experience a Qualifying Status Change (QSC) event. The IRS regulations regarding pre-tax premium plans do not allow for enrollment, additions, changes, or cancellations except with the occurrence of a Qualifying Status Change event, followed by written application for a change within a prescribed time frame. The Federal Government determines the events that qualify as QSC's, and this list is subject to periodic change.

An employee who wishes to change a benefit election on the basis of a QSC must complete the following steps within 31 days of the QSC event:

1.	Contact the People First Service Center (866-663-4735) or Human Resources Benefits (727-873-4838) to report the QSC event and date.
2.	Complete all required forms authorizing the desired change.
3.	Provide the supporting documentation (as listed in the chart below). *Not all events are listed, please contact People First or Human Resources Benefits for other eligible events.
4.	People First must receive the required enrollment forms within 31 days of the QSC event. If the forms are received more than 31 days after the event, the request will be denied and can not be made until the next Annual Open Enrollment period, which usually occurs during the fall.

Code	Qualifying Event	Documentation Requirements
1	Marriage	Marriage Certificate, Proof of Eligibility if adding other Dependents
2	Divorce	Divorce Decree
3	Employee begins Unpaid Leave ( Including Military Leave)	Documentation will be provided by your Employer
4	Employee returns from Unpaid Leave (Including Military Leave)	Proof of Eligibility if adding Dependents
5	Death of Spouse or Dependent	Death Certificate
6	Ineligibility of Dependent	No Documentation Needed
7	Birth or Adpotion (Including foster care placement, guardinaship, adoption placement)	Birth Certificate, Adoption Papers, Court Documents, Proof of Eligibility if adding other Dependents
8	Employment of Spouse (resulting in a gain in coverage)	Documentation will be provided by your Spouse's Employer
9	Termination of Spouse's Employment (resulting in a loss of coverage)	Documentation will be provided by your Employer
10	Begin Unpaid Leave by Spouse (resulting in loss of coverage)	Documentation will be provided by your Spouse's Employer
11	Return from Unpaid Leave by Spouse (resulting in a gain of coverage)	Documentation will be provided by your Spouse's Employer
12	Change from Part-Time to Full-Time of Employee	Documentation will be provided by your Employer
13	Change from Full-Time to Part-Time of Employee	Documentation will be provided by your Employer
14	Change from Part-Time to Full-Time by Spouse (resulting in a gain of coverage)	Documentation will be provided by your Spouse's Employer
15	Change from Full-Time to Part-Time by Spouse (resulting in loss of coverage)	Documentation will be provided by your Spouse's Employer
17	Change in Coverage due to Spouse's Employment (open enrollment, health plan addition or deletion; by a non-state employer)	No Documentation Needed
20	Spouse Program Enrollment	Spouse Program Enrollment Form
21	Spouse Program Dis-enrollment	Spouse Program Enrollment Form
22	Termination of Employment (except retirement)	Documentation will be provided by your Employer
23	Dependent Satifies Eligibilty Requirements	Proof of Eligibilty if adding Dependents
24	Retirement	Documentation will be provided by your Employer
27	Commencement or Return from Family Medical Leave (FMLA)	Documentation will be provided by your Employer
28	Change of Residence resulting in Loss of Eligibility (moved outside HMO service area)	Proof of Address Change
30	Court Order that Requires Coverage for a Child under the Employee's Plan	Copy of Court Order
31	Court Order that requires Spouse, Former Spouse or Other Individual to provide Coverage for a Child	Copy of Court Order and Proof of other Coverage
32	Layoff of Participant	Documentation will be provided by your Employer
34	Layoff of Employee's Spouse	Proof of Eligibility if adding Dependents
36	Gain of Entitlement for Medicare or Medicaid (other than coverage solely for pediatric vaccines)	Letter or other Documentation of Gain of Eligibility
37	Loss of Entitlement for Medicare or Medicaid (other than coverage solely for pediatric vaccines or to other Group Health Plan Sponsored by a Governmental or Educational Entity, including Healthy Kids Programs)	Letter or other Documentation of Eligibility. Proof of Eligibility if adding Dependents. Certificate of Coverage if Pre-Existing Condition applies.