| Type of Event | Date of Submission | Change Effective Date |
|---|---|---|
| New Hire/Rehire* | No later than 60 days from date of eligibility | Group determines but not to exceed 90 days from date of hire. |
| Marriage* | Within 31 days following marriage | First of the month following marriage |
| 32 - 60 days following marriage | First of the month following receipt | |
| After 60 days following marriage (small group) | First of the month following receipt | |
| After 60 days following marriage (large group) | Void - must wait until next open enrollment | |
| Birth* | Newborn is automatically added for first 60 days Within 60 days following the date of birth, to continue coverage or to request other changes to your coverage | Date of birth for child and 61st day after the birth for the membership type change |
| After 60 days following birth (small group) | First of month following receipt | |
| After 60 days following birth (large group) | Void - must wait until next open enrollment | |
| Adoption* | Within 60 days following adoption (or placement for adoption) | Date of adoption (or placement for adoption) |
| After 60 days following birth (small group) | First of month following receipt | |
| After 60 days following birth (large group) | Void - must wait until next open enrollment | |
| Death | Within 6 months of the date of death | Date of death |
| Divorce | Within 60 days of divorce | First of the month following divorce |
| Qualifying Loss of Coverage* | Within 31 days after notification of loss of coverage | Retroactive to date of coverage loss |
| Voluntary Cancellation | Must submit Group Enrollment Form with employee signature | First of the month following receipt |
| Left Employment | Submit Group Membership Update Form indicating key word as "LE" | First of the month following receipt |
| COBRA Eligibility | If subscriber accepts COBRA within 60 days, he or she can be retroactively reinstated | Not Applicable |
| 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 | |
* Requests not received as indicated above can be processed on your anniversary or open enrollment.
- All group enrollment & change forms must be signed and dated by the subscriber.
- All membership update forms must be signed and dated by the appropriate group representative.