Special Open Enrollment - Subscriber or Dependent is No Longer Eligible for a Medical Assistance Program


If you are the subscriber and are currently enrolled with medical and dental coverage

Options

  • You may enroll eligible dependent(s) in your medical and/or dental insurance plan.
  • You may change your medical and/or dental plan only if you are also enrolling your newly-eligible dependent(s) in the plan.

Required Actions

  • Within 60 days after notification from the Department of Social and Health Services (DSHS), submit the following documentation to the Benefits Office:
    • Employee Enrollment/Change Form
    • Copy of the letter from DSHS indicating you and/or your dependent(s) are no longer eligible for a medical assistance program, such as Medicaid or Children's Health Insurance Program (CHIP).
    • Any required dependent certification forms (e.g. Extended Dependent or Dependent with Disabilities).
    • Dependent Verification Documents

 


If you are the subscriber and you previously waived medical coverage

Options

  • You may enroll yourself in medical coverage if you do not have other group medical coverage.
  • You may enroll yourself in medical insurance to add eligible dependent(s) in medical coverage.

Required Actions

  • Within 60 days after notification from the Department of Social and Health Services (DSHS), submit the following documentation to the Benefits Office:
    • Employee Enrollment/Change Form
    • Copy of the letter from DSHS indicating you and/or your dependent(s) are no longer eligible for a medical assistance program, such as Medicaid or Children's Health Insurance Program (CHIP).
    • Any required dependent certification forms (e.g. Extended Dependent or Dependent with Disabilities).
    • Dependent Verification Documents

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Coverage Begins

  • Health insurance coverage and/or plan changes begin on the first day of the month following notification of eligibility loss for Medicaid or CHIP.

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Optional

You may enroll, change, or cancel your participation in these optional tax-savings programs:

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Resources

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Page Updated 11.19.2013