Employee Enrollment Changes & Medical Leave of Absence

Employee Enrollment Changes

(Special Enrollment Events)

Employees may change certain MIT benefit elections outside of the annual enrollment period when they experience a “special enrollment event”. The following are considered special enrollment events if the event affects eligibility for MIT benefits resulting in a gain or loss of MIT benefit coverage, or access to MIT benefit coverage for the employee or their Dependent:

Change in legal marital status;
Change in the number of Dependent children;
Change in employment status or work schedule of you or your Dependent;
Change in your Dependent child’s eligibility to participate in a MIT benefit due to attainment of age or change in full-time student status, or
Change in place of residence for you or your Dependent.

MIT must receive your request to make the corresponding change to your MIT benefit enrollment within 31 days of any of the above special enrollment events. For medical or dental benefits, you may also change your election if:

Previously Declined Enrollment

You decline enrollment for yourself and/or your Dependent under any MIT medical or dental benefit because you or your Dependent (as applicable) had other group medical or dental coverage and either (a) you or your Dependent later lose eligibility for that coverage, or (b) you marry. You must request enrollment within 31 days after the date upon which the other coverage is lost or the marriage event occurred.
You add a new Dependent child through birth, adoption or placement for adoption, in which case you must request enrollment within 90 days after the date of birth, adoption or placement for adoption. Important: Regardless of whether you are enrolled in family coverage, if you have a baby through birth or adoption, be sure to enroll your new dependent within 90 days or else the child will not be able to enroll until the next annual enrollment period for your Participating Employer.

Entitlement or Loss of Medicare or Governmental Program. You or your Dependent become entitled to or lose eligibility for Medicare or eligibility under a governmental program.

MIT must receive your request to make the corresponding change to your MIT medical or dental enrollment within the designated 31 or 90-day time period following any of the above special enrollment events. These medical and dental election changes and corresponding required contribution increases or refunds are retroactive to the date of the event. Failure to notify MIT within 31 or 90 days (as applicable) of any of the above special enrollment events may result in your inability to make changes to your MIT coverage.

An additional special enrollment event occurs if you or your Dependent lose coverage under a state Medicaid or state Children’s Health Insurance Plan (“CHIP”) because of loss of eligibility. If this occurs, you may enroll yourself and your Dependent in a MIT medical benefit, provided you request enrollment within 60 days of the date upon which you lose the Medicaid or CHIP coverage. This special enrollment eligibility only applies if you or your eligible Dependent’s Medicaid or CHIP coverage terminates due to loss of eligibility (as opposed to termination due to failure to pay Employer Contributions). You may also enroll yourself and your eligible Dependents for a MIT medical benefit if you or your Dependents become eligible for Medicaid or CHIP premium assistance to help you pay for Plan coverage, provided you enroll yourself and/or your Dependent within 60 days of the date you or your Dependent is determined to be eligible for such premium assistance. Federal regulations require that election changes made because of a special enrollment event must be consistent with the type of change you have experienced. We will determine if a requested change in coverage is consistent with your corresponding special enrollment event. Besides legal requirements discussed above, the Summary for the applicable MIT benefit or your Participating Employer’s cafeteria plan may further restrict changes you may make to your benefit elections, including changes due to a special enrollment event. In addition, rules describing additional changes you may make may be included in the for the applicable MIT benefit. In the case of a special enrollment event that resulted in the loss of your or your covered Dependent’s eligibility for MIT benefit coverage, your failure to timely notify MIT of the event may result in the permanent loss of your eligibility to participate in all MIT benefits for you and your eligible Dependent. MIT reserves the right to retroactively terminate coverage back to the earliest date that an individual becomes ineligible for a MIT benefit and to seek repayment of all amounts paid by MIT for ineligible expenses (except when limited by law).

Leave of Absence

If an employee is unable to work due to disability, and their employer has authorized a leave of absence, the employee and their covered dependents may remain eligible for insurance under the Plan for a maximum of twelve (12) weeks. It is the employer’s responsibility to notify MIT when an employee has left on a medical leave and when they return back to work.

If the employee has not returned to work after the 12 weeks has run up, the employee and their covered dependents may be eligible to elect COBRA Continuation Coverage.

See the benefits status change process for Leave of Absence by clicking HERE.

Employee Enrollment Changes & Medical Leave of Absence