Life Changing Events

Acceptable Documentation:

Copy of finalized court documents indicating date of event.

Effective Date of Coverage:

Earlier of:
(i) the moment of birth for a newborn child if a petition for adoption was filed within 31 days of the birth of the child; (ii) the date the petition for adoption was filed; or (iii) date of child’s placement.

**Date of placement for adoption means the date you assume the legal obligation for total or partial support of the child to be adopted in connection with formal adoption proceedings.

Acceptable Documentation:

Birth certificate, Hospital Crib Card or Hospital invoice showing name and date of child’s birth.

Effective Date of Coverage:

Date of Birth

Acceptable Documentation:

If you, no forms required. If spouse or dependent, letter/form from spouse’s or dependent’s old or new employer indicating the gain or loss of employment. Letter/form must indicate coverage type(s), last date of coverage or first date coverage is available, and who was or will be covered.

Effective Date of Coverage:

First day following the date the other coverage terminates or day prior to the date coverage begins.

* Reduction in hours or termination of employment resulting in end of insurance eligibility or new employment or increase in hours resulting in new insurance eligibility

Acceptable Documentation:

Copy of enrollment verification which indicates coverage start date.

Effective Date of Coverage:

Day prior to the date coverage begins.

Acceptable Documentation:

Letter/form indicating the gain or loss of coverage. Letter/form must indicate last date of coverage or first date coverage is available and what type(s) of coverage are beginning or ending. 

Effective Date of Coverage:

First day following the date the other coverage terminates or day prior to the date coverage begins.

^ Loss of eligibility for coverage does NOT include termination of coverage due to untimely payment of premiums or termination for cause. In addition, dropping or cancelling an individual insurance plan is NOT an eligible qualifying event.

Acceptable Documentation:

Letter/form indicating the gain or loss of coverage. Letter/form must indicate last date of coverage or first date coverage is available.

Effective Date of Coverage:

First day following the date the other coverage terminates or day prior to the date coverage begins.

Acceptable Documentation:

Copy of court order awarding full guardianship.

Effective Date of Coverage:

Date of legal guardianship as indicated in court documents.

Acceptable Documentation:

Copy of medical support order or court documents.

Effective Date of Coverage:

Date indicated in medical support order or court documents.

Acceptable Documentation:

Self: Letter/form indicating the resulting loss of coverage. Letter/form must indicate last date of coverage.
Spouse: Copy of finalized court documents indicating date of event.
Child(ren): Copy of finalized court documents indicating date of event. If coverage is not court ordered, must supply a letter/form indicating the gain or loss of coverage. Letter/form must indicate last date of coverage or first date coverage is available.

Effective Date of Coverage:

Self: First day following the date the other coverage terminates
Spouse: Date of Divorce.
Child(ren): First day following the date the other coverage terminates or day prior to the date coverage begins.

Acceptable Documentation:

Marriage certificate indicating both parties and date of marriage.

Effective Date of Coverage:

Date of Marriage

Acceptable Documentation:

Letter from spouse’s or dependent’s employer indicating an open enrollment change. Letter must indicate coverage type(s), last date of coverage or first date coverage is available, and who was or will be covered.

Effective Date of Coverage:

First day following the date the other coverage terminates or day prior to the date coverage begins.