Special Open Enrollment - Subscriber or Dependent Loses Other Comprehensive Group Insurance Coverage


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

Options

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

Required Actions

  • Within 60 days of the loss of coverage, submit these forms to the Benefits Office:
    • Employee Enrollment/Change Form
    • Any required Dependent Certification Forms
    • Proof of Loss Statement from the insurance company or a letter from previous employer indicating date of loss the family members that were covered.

 


If you are the subscriber and your previously waived medical coverage

Options

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

Required Actions

  • Within 60 days of the loss of health insurance coverage, submit these forms to the Benefits Office:
    • Employee Enrollment/Change Form
    • Extendend Dependent Certification Form
    • Proof of Loss Statement from the insurance company or a letter from previous employer indicating date of loss the family members that were covered.

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Coverage Begins

  • Coverage and/or plan change begins on the first day of the month following the loss of health insurance coverage unless the loss of coverage occurs on the first day of the month, then coverage and/or plan changes begin on that day.

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Optional

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Resources

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Page Updated 11.19.2013