Special Open Enrollment - Subscriber or Dependent Becomes Eligible for a Medical Assistance Program

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


  • You may change your medical and/or dental insurance plan only if you enroll the newly eligible dependent on your plan.
  • You may waive medical insurance for yourself, and medical and/or dental insurance for your eligible dependents only if they all have other comprehensive group medical insurance coverage.

Required Actions

  • Within 60 days after notification from the Department of Social and Health Services (DSHS), submit these forms to the Benefits Office:
    • Employee Enrollment/Change Form
    • Copy of the letter from DSHS indicating you and/or your dependent(s) are eligible for a medical assistance program, such as Medicaid or Children's Health Insurance Program (CHIP).


Coverage Begins

  • Health insurance coverage and/or plan change begins on the first day of the month following notification of eligibility for Medicaid or CHIP.
  • If you are waiving coverage, insurance coverage ends the last day of the month in which you were notified of eligibility for Medicaid or CHIP.

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Page Updated 12.15.2014