Qualifying Life Events

Qualifying Life Events: Employees who experience any of the following qualifying life events have 31 days from the date of the event to make changes to insurance coverage by submitting an application and required supporting documentation.

1. Click here to print the application to update your health insurance.  (The application is not setup to be filled out or submitted online.)
2. Fill out the application.
3. Attach the required documentation to update your insurance as explained on the chart below or see the application.
   • Applications turned in without the required documentation are incomplete.  If the completed application and requested information is not returned by the deadline, no coverage will take effect.
   • Please send copies of the documentation. Originals will not be returned.
4. Do you have a family member that works for WinCo?
   • If no, go to #5.
   • If yes, and you are covered by his/her health insurance, you have the option to separate coverage to your own plan or you can combine/transfer coverage with an eligible family member (legal spouse, dependent child under 26).
   • Click here for the Transfer/Combine or Separate Coverage Form.
   • WinCo’s plan does not double cover anyone covered by another WinCo employee. For example, two employees cannot cover the same child on 2 separate policies. For questions about this, contact Benefits.
   • Combine/transfer coverage becomes effective the first day of the next month following the qualified life event.
5. Complete the Beneficiary Form. (This is not the same as the ESOP/401K beneficiary form.) Click here for the form.
6. Turn in your application, form, and required documentation, if applicable, following the instructions on the form as soon as possible to the Benefits Department. Applications and documentation CANNOT be accepted by email. The deadline to turn in your application and documentation is based on the event and is generally 31 days.
7. After your application and documentation is processed, you will receive a letter in the mail stating the change took place.

Life Event	Time Limit	Documentation Required
Birth/child	31 days from the date of the birth. (Newborn – social security number due 30 days after application received if pending at time of application.)	Official document with child’s name, your name (parent), and date of birth: birth certificate, souvenir birth certificate, document issued by the hospital at time of birth (no discharge paperwork), or court documentation signed by a judge. Step-child(ren) – copy of child’s birth certificate showing your legally married spouse as parent and copy of legal, certified marriage certificate showing the names of you and your spouse.
Marriage	31 days from the date of the marriage.	Legal, certified marriage certificate.   Alternate document: souvenir marriage certificate. Common law, civil union, or similar documentation not accepted.
Adoption, gain legal guardianship	31 days from the date of the birth/event.	Court documentation signed by a judge.  Alternate documents:  child support, social services, or adoption agency paperwork, signed by a social worker or agency official.
Death of dependent	Within 7 days of the event. If over 7 days, notify ASAP.	Death certificate (original copy not needed).
Divorce, legal separation, annulment	Within 7 days of the event. If over 7 days, notify ASAP.	Official court divorce decree with judge’s signature evidencing date the divorce was final.
Gained other health insurance coverage	31 days from the date other coverage started for the affected dependent or to cancel whole plan (to cancel whole plan, all dependents must have new coverage within last 31 days).	Letter from new insurance company showing the name(s) of who you are dropping and the new coverage effective date.
Loss of other health insurance coverage	31 days from the date of the loss of coverage.   60 days for federal or state coverage.	Termination letter from previous insurance provider showing the name(s) of who you are adding and the coverage end date. To add dependent(s), provide proof of marriage and/or proof of parentage.
Newly eligible –insurance reinstated due to hours	31 days from the date of the event.	If you lost coverage due to low hours, coverage will restart automatically once hours requirement met.  If you lost coverage for any other reason or declined coverage and your hours also dropped, you can apply for coverage.  To add dependents, provide proof of marriage and/or proof of parentage.

Please note: pregnancy is not a qualified life event that allows changes. Changes to current policies are allowed with a qualified life event or during open enrollment.