Opportunities for Adding a Dependent
A dependent(s) may be added to an existing policy during:
- open enrollment
- special enrollment (triggered by a qualified event)
Group Enrollment Form
|Form must be signed and dated by employee|
Additional documentation requirements:
NOTE: When adding a domestic partner or adult dependent due to disability, additional documentation requirements apply.
Events Most Likely to Result in Addition of Dependent
If any of these events listed below occur, you may request coverage for an eligible dependent.
|Event||Form Deadline||Effective Date|
|No later than 60 days from date of eligibility||Group determines but not to exceed 90 days from date of hire.|
|Within 31 days following marriage/civil union.||First of the month following marriage/civil union.|
|32 to 60 days following marriage/civil union.||First of the month following receipt.|
|Within 60 days following birth.||Date of birth for child and 61st day after the birth for the membership type change.|
|61 to 90 days following birth.||First of the month following receipt.|
|Within 60 days following adoption (or placement for adoption).||Date of adoption (or placement for adoption).|
|61 to 90 days following adoption (or placement for adoption).||First of the month after we receive the request.|
Qualifying Loss of Coverage
|Within 31 days after loss of coverage.||Retroactive to date of coverage loss.|
Medicare Supplemental Coverage
Within 90 days of the date of Medicare coverage
|Date of Medicare entitlement. If received prior to Medicare effective date, coverage will be effective to coincide with Medicare.|
Addition of Employee who refused initial enrollment.
|Prior to the Anniversary or Open Enrollment month.|
First of the Anniversary or Open Enrollment month.
|During the Anniversary or Open Enrollment month.||First of the month following receipt.|