Life Event Matrix

Please review the Life Event Matrix before completing the required form.

When you enroll in medical insurance, dental insurance, vision, life insurance, health flexible spending or dependent care assistance program, you cannot make any changes to your benefit elections until the next open enrollment period unless you experience a qualified life event and the benefit change you request is consistent with the event. Qualified events are defined by Section 125 of the Internal Revenue Code, based on individual circumstances and plan eligibility.

  • You have 31 days from the date of the event to request a change to your benefits due to a qualifying life event within Workday (County Paid Employees and other benefit affiliates, please reach out to your HR contact to complete the change). 
  • 60 days is allowed for birth of baby or adoption.  
  • Voluntary Supplemental Term Life Insurance may be canceled at any time throughout the year.
  • Comprehensive Dental Plan – may not change from comprehensive dental to basic dental plan until the 3-year lock-in period has been satisfied.

Change in Marital Status

Marriage or Declaration of Domestic Relationship
Effective 1st of the month on or after event date

Medical/Rx, Dental & Vision Plans

- May enroll newly eligible spouse/partner and other newly eligible dependents
- May cancel coverage if you become covered by your spouse/partner’s plans

Health Flexible Spending Account

- May enroll or increase contribution
- May decrease contribution (cannot drop below the amount that’s been claimed)
- May cancel contribution if you become covered by your spouse health FSA plan

Dependent Care Assistance Program

- May enroll in account
- May increase contribution if marriage increases dependent care expenses
- May decrease contribution if the family elects dependent care assistance under spouse plan or marriage decreases dependent care expenses

Life Insurance (Not applicable to Pre/Post-Doc appointments)

- May apply for Basic Term Life and Voluntary Term Life within 31 days (medical underwriting required)*
- Dependent Term Life: may add coverage for spouse/partner and  spouse/partner’s eligible dependents
- If adding Dependent Term Life, must be enrolled in Basic Term Life

Documentation

 Copy of marriage certificate or Declaration of Relationship form plus document verifying living at same address
(If adding new dependents with marriage, birth certificates are required)

Divorce Annulment Legal Separation
Effective 1st of the month on or after the event date

Medical/Rx, Dental & Vision Plans

 - Must remove former spouse/partner and spouse/partner’s eligible dependents
- Cannot remove other dependents from coverage unless they are added to former spouse/partner’s plan
- May enroll in coverage/add dependents if the event causes loss of coverage under former spouse/partner’s plan

Health Flexible Spending Account

 - May decrease contribution to reflect loss of your spouse/partner’s eligibility (cannot drop below the amount that’s been claimed)
- May enroll or increase contribution if coverage is lost under your spouse/partner’s health FSA plan

Dependent Care Assistance Program

 - May enroll in account
- May increase contributions if event increases dependent care expenses or causes loss of coverage under spouse/partner’s plan
- May decrease contributions if event decreases dependent care expenses

Life Insurance (Not applicable to Pre/Post-Doc appointments)

 - May apply for Basic Term Life and Voluntary Term Life within 31 days (medical underwriting required)*
- Dependent Term Life: must remove former spouse/partner and spouse/partner’s eligible dependents

Documentation

 Copy of divorce decree or certificate of annulment or legal separation 

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Dependent Status Change

Spouse/Partner Death
Effective 1st of the month following event date

Medical/Rx, Dental & Vision Plans

 - Remove spouse/partner from coverage
- May enroll in coverage or add any dependent that loses coverage under deceased spouse/partner’s plan

Health Flexible Spending Account

 - May decrease contribution (cannot drop below the amount that’s been claimed)
- May enroll or increase contribution if coverage is lost under your spouse/partner’s health insurance or health FSA plan

Dependent Care Assistance Program

 - May enroll in account
-May increase contribution

Life Insurance (Not applicable to Pre/Post-Doc appointments)

 - Basic Term Life:  no change
- Voluntary Term Life:  may apply for coverage within 31 days (medical underwriting required)*
- Dependent Term Life:  cancel coverage for deceased member

Documentation

 Copy of death certificate

Dependent Death
Effective 1st of the month following the event date

Medical/Rx, Dental & Vision Plans

 - Remove dependent from coverage

Health Flexible Spending Account

 - May decrease contribution (cannot drop below the amount that’s been claimed)

Dependent Care Assistance Program

 - May decrease contribution or cancel contribution if you have reduced dependent care expenses

Life Insurance (Not applicable to Pre/Post-Doc appointments)

 - Basic Term Life:  no change
- Voluntary Term Life:  no change
- Dependent Term Life: cancel coverage for deceased member

Documentation

 Copy of death certificate

Birth or Adoption
Effective as of event date

Medical/Rx, Dental & Vision Plans

 - May add newly eligible dependent to existing plans
- May cancel coverage if become covered by spouse/partner’s plan
- May add spouse/partner and other eligible dependents if losing coverage under another plan

Health Flexible Spending Account

 - May enroll or increase contribution
- May decrease contribution (cannot drop below the amount that’s been claimed)

Dependent Care Assistance Program

 - May enroll in account
- May increase contribution

Life Insurance (Not applicable to Pre/Post-Doc appointments)

 - May apply for Basic Term Life and Voluntary Term Life (medical underwriting required)*
- Dependent Term Life:  may enroll newly eligible dependent
- If adding Dependent Term Life, must be enrolled in Basic Term Life Insurance

Documentation

 Copy of birth certificate or certificate of adoption

Dependent Status Change
becomes a full-time student (> age 26 and unmarried)
Effective 1st of the month following event date

Medical/Rx, Dental & Vision Plans

 - May enroll newly eligible dependent to existing plans

Health Flexible Spending Account

 - No change allowed

Dependent Care Assistance Program

 - No change allowed

Life Insurance (Not applicable to Pre/Post-Doc appointments)

 - Basic Term Life:  No change

Documentation

 Verification of full-time student status (examples:  copy of class schedule, letter from college or university)

Dependent Status Change
no longer eligible (> age 26 and married or not a full-time student)
Effective 1st of the month following event date

Medical/Rx, Dental & Vision Plans

 - Remove dependent that is no longer eligible

Health Flexible Spending Account

 - May decrease contribution (cannot drop below the amount that’s been claimed)

Dependent Care Assistance Program

 - No change allowed

Life Insurance (Not applicable to Pre/Post-Doc appointments)

 - Basic Term Life:  no change
- Dependent Term Life: end coverage for dependent that’s no longer eligible

Documentation

 Copy of marriage certificate

Dependent Status Change
Judgment, Decree or Order (including QMCSO)
Effective as of event date

Medical/Rx, Dental & Vision Plans

 - May add dependent to existing plan if required under order
- May cancel dependent if other parent provides coverage under order

Health Flexible Spending Account

 - May enroll or increase contribution if adding dependent to coverage
- May decrease contribution if dropping dependent from coverage (cannot drop below the amount that’s been claimed)

Dependent Care Assistance Program

 - May enroll, increase or decrease contribution

Life Insurance (Not applicable to Pre/Post-Doc appointments)

 - No change allowed

Documentation

 Copy of judgment, decree or court order

Dependent age 26

Medical/Rx, Dental & Vision Plans

 - Allowed to remain on coverage through December 31st of the year dependent turns 26

Health Flexible Spending Account

 - No changes

Dependent Care Assistance Program

 - No changes

Life Insurance (Not applicable to Pre/Post-Doc appointments)

 - Dependent life coverage ends at the end of the month in which dependent turns 26

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Insurance Status Change

Employee, Spouse/Partner or Dependent loses eligibility for coverage
Effective 1st of the month on or after event date

Medical/Rx, Dental & Vision Plans

 - May enroll in coverage
- May add eligible family members if they lost coverage under another plan

Health Flexible Spending Account

 - May enroll in account
- May increase contribution

Dependent Care Assistance Program

 - May enroll in account or increase contribution
- May decrease or cancel contribution

Life Insurance (Not applicable to Pre/Post-Doc appointments)

 - No change allowed

Documentation

Letter from employer or insurance company verifying member names and date the coverage will end

Copy of marriage certificate if adding spouse

Copy of birth certificate if adding child(ren)

Employee, Spouse/Partner or Dependent gains eligibility for coverage
Effective 1st of the month on or after event date

Medical/Rx, Dental & Vision Plans

 - May cancel coverage for yourself and/or eligible dependents if become covered by another plan

Health Flexible Spending Account

 - May decrease contribution (cannot drop below the amount that’s been claimed)

Dependent Care Assistance Program

 - May enroll in account or increase contribution
- May decrease or cancel contribution

Life Insurance (Not applicable to Pre/Post-Doc appointments)

 - No change allowed

Documentation

 Letter from employer or insurance company verifying member names and the effective date of new coverage

Double Spouse/Partner Benefit: existing employee's spouse/partner begins employment at ISU and insuring family
Change effective first of the month following spouse/partner hire date, unless  both are new employees hired on the same date.

Medical/Rx, Dental & Vision Plans

 - Enroll in double spouse/partner option for medical and dental plans for the first of the month following spouse/partner's hire date. 
- One employee is double spouse contract holder; spouse/partner should waive medical and dental option

Health Flexible Spending Account

 - No changes

Dependent Care Assistance Program

 - May enroll in account or increase contribution

Life Insurance (Not applicable to Pre/Post-Doc appointments)

 - Basic Term Life:  no change
- Voluntary Term Life:  no change
- Dependent Term Life: end coverage for spouse/partner that’s no longer eligible

Documentation

 Double spouse benefit form

Double Spouse/Partner Benefit begins due to birth of baby or adoption

Medical/Rx, Dental & Vision Plans

 - Employee adds baby to health insurance (self and child) for month of birth; then does life event for spouse losing coverage to change to double spouse effective first of the month following birth of baby
- Spouse also needs to do life event for gaining coverage and needs to waive the current self only coverage

Health Flexible Spending Account

 - May enroll in account
- May increase contribution

Dependent Care Assistance Program

 - May enroll in account

Life Insurance (Not applicable to Pre/Post-Doc appointments)

 - Basic Term Life:  no change
- Voluntary Term Life:  no change
- Dependent Term Life: one employee may add coverage for new baby

Documentation

 Birth certificate

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Employment Status Change

Employee no longer benefits eligible - less than 20 hours per week

Medical/Rx, Dental & Vision Plans

 - Coverage terminates at the end of the month in which eligibility changes
- May continue coverage through COBRA for up to 18 months, if not eligible for Medicare

Health Flexible Spending Account

 - Contribution terminates at the end of the month in which eligibility changes
- May continue to submit claims but only for expenses incurred while you were an eligible employee
- May continue participation on an after-tax basis through COBRA for the remainder of the year

Dependent Care Assistance Program

 - Contributions terminate at the end of the month in which eligibility changes
- May continue to submit claims but only for expenses incurred while you were an eligible employee or while you were employed elsewhere or looking for employment

Life Insurance (Not applicable to Pre/Post-Doc appointments)

 - Coverage terminates at the end of the month in which eligibility changes
- May continue coverage under the conversion privilege or portability provision

Employee becomes benefits eligible - 20 to 40 hours per week

Medical/Rx, Dental & Vision Plans

 - May enroll in coverage – effective as of event date

Health Flexible Spending Account

 - May enroll in account – effective as of event date

Dependent Care Assistance Program

 - May enroll in account – effective as of event date

Life Insurance (Not applicable to Pre/Post-Doc appointments)

 - May enroll/apply for Basic Term Life, Voluntary Term Life and Dependent Term Life Insurance  - Basic Term Life required for Voluntary and Dependent Term Life
- Effective 1st of the month following event date

Documentation

 Marriage certificate if adding spouse;  birth certificate if adding child(ren)

Rehired less than 30 days after termination of employment

Medical/Rx, Dental & Vision Plans

 - ISU will reinstate prior plan elections
- Coverage begins as of hire date

Health Flexible Spending Account

 - ISU will reinstate prior contribution
- Coverage begins as of hire date

Dependent Care Assistance Program

 - ISU will reinstate prior contribution
- Coverage begins as of hire date

Life Insurance (Not applicable to Pre/Post-Doc appointments)

 - ISU will reinstate prior coverage
- Coverage begins 1st of the month following hire date

Termination /Separation of Employment

Medical/Rx, Dental & Vision Plans

 - Coverage terminates at the end of the month in which you separate
- May continue coverage through COBRA for up to 18 months, if not eligible for Medicare

Health Flexible Spending Account

 - Contribution terminates at the end of the month in which you separate
- May continue to submit claims but only for expenses incurred while you were an eligible employee
- May continue participation on an after-tax basis through COBRA for the remainder of the year

Dependent Care Assistance Program

 - Contributions terminate at the end of the month in which you separate
- May continue to submit claims but only for expenses incurred while you were an eligible employee or while you were employed elsewhere or looking form employment

Life Insurance (Not applicable to Pre/Post-Doc appointments)

 - Coverage terminates at the end of the month in which you separate
- May continue coverage under the conversion privilege or portability provision

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Leave of Absence

Begin unpaid leave in excess of one continuous calendar month (No FMLA)

Medical/Rx, Dental & Vision Plans

 - May elect to continue coverage – employee billed for total cost of premiums
- May cancel coverage

Health Flexible Spending Account

 - May continue contributions
- May cancel contributions

Dependent Care Assistance Program

 - May continue contributions
- May cancel contributions

Life Insurance (Not applicable to Pre/Post-Doc appointments)

 - Basic Term Life:  may continue or cancel coverage
- Voluntary Term Life:  may continue or cancel coverage
- Dependent Term Life:  may continue or cancel coverage

Begin unpaid FMLA leave in excess of one continuous calendar month

Medical/Rx, Dental & Vision Plans

 - May cancel coverage
- May continue coverage – billing for any premiums due at the same cost share as active employees

Health Flexible Spending Account

 - May continue contributions
- May cancel contributions

Dependent Care Assistance Program

 - May continue contributions
- May cancel contributions

Life Insurance (Not applicable to Pre/Post-Doc appointments)

 - Basic Term Life:  no change
- Voluntary Term Life and Dependent Term Life:  may continue or cancel coverage

Return from unpaid leave or unpaid FMLA in excess of one continuous calendar month

Medical/Rx, Dental & Vision Plans

 - May re-enroll prior elections

Health Flexible Spending Account

 - May re-enroll prior contribution

Dependent Care Assistance Program

 - May re-enroll prior contribution

Life Insurance (Not applicable to Pre/Post-Doc appointments)

 - May re-enroll prior coverage – medical underwriting approval required

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Retirement

Employee’s Retirement

Medical/Rx, Dental & Vision Plans

 - Current coverage terminates at end of the month in which you retire
- May be eligible for retiree medical and dental coverage
- May change medical plan
- May cancel coverage anytime throughout the year

Health Flexible Spending Account

 - Contributions terminate
- May continue to submit claims but only for expenses incurred while you were an eligible employee
- May continue participation on an after-tax basis through COBRA for the remainder of the year

Dependent Care Assistance Program

 - Contributions terminate
- May continue to submit claims but only for expenses incurred while you were an eligible employee

Life Insurance (Not applicable to Pre/Post-Doc appointments)

 - Basic Term Life:  coverage terminates at end of the month in which you retire; may be eligible for retiree $4000 life policy
- Voluntary Term Life and Dependent Term Life:  may continue coverage under the conversion privilege or portability provision

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Change in Dependent Care Provider

Change in childcare provider rates or number of hours worked by provider
Effective 1st of the month following event date

Medical/Rx, Dental & Vision Plans

 - No change allowed

Health Flexible Spending Account

 - No change allowed

Dependent Care Assistance Program

 - May enroll in account or increase contribution
- May decrease or cancel contribution

Life Insurance (Not applicable to Pre/Post-Doc appointments)

 - No change allowed

Documentation

 Flex Spending Account Salary Reduction Agreement

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Change in Residence

Relocate out of state of Iowa
Effective 1st of the month on or after event date

Medical/Rx, Dental & Vision Plans

 - May change from HMO to PPO medical plan
- No change to dental or vision plans

Health Flexible Spending Account

 - No change allowed

Dependent Care Assistance Program

 - May increase or decrease contribution if child care provider changes

Life Insurance (Not applicable to Pre/Post-Doc appointments)

 - No change allowed

Documentation

 Update home address in Workday

Spouse and/or dependent child(ren) arrival to U.S.
Effective as of event date

Medical/Rx, Dental & Vision Plans

 - May add newly eligible dependents to existing plans

Health Flexible Spending Account

 - May increase contribution if already enrolled in FSA

Dependent Care Assistance Program

 - May enroll in account

Life Insurance (Not applicable to Pre/Post-Doc appointments)

 - No change allowed

Documentation

 Copy of passports with dates of arrival; marriage certificate; birth certificate for child(ren)

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