Making Changes/Life Events

You may enroll for coverage, change your plan choices, add/drop family members, or discontinue your Fund-provided coverage once each year during annual Open Enrollment.

Outside of Open Enrollment, you can change your plan choices for any reason once in a five-year period.  You can also make certain changes if you or a dependent has a special enrollment right due to a qualified life event.  

Be sure to contact the Fund Office if you have questions about changing your coverage outside of Open Enrollment.

 

Qualified Life Events and Special Enrollment Rights

You, your spouse/domestic partner, and/or your dependent child(ren) may be eligible to be enrolled in the Fund’s medical coverage (or change your previous elections) outside Open Enrollment under the following circumstances:

  • If you or one of your dependents lose other medical coverage (including coverage under a state Medicaid program or a state Children’s Health Insurance Program (CHIP)).
  • If an employer stopped contributing towards your or your dependent’s other coverage.
  • If you acquire a new dependent (for example as a result of a marriage, domestic partnership, birth, adoption, placement for adoption, or placement of a foster child).
  • If you or any of your dependents become eligible for premium assistance through a state's premium assistance program (such as the California Health Insurance Premium Program (HIPP)).

You need to request a special enrollment within 120 calendar days of these events. Your coverage will be retroactive to the date the event occurred.  

However, Kaiser and UHC Participants should note that the HMOs may limit the period for retroactive enrollment and coverage. If unavailable through the HMO, your retroactive coverage will be provided through the Indemnity PPO Medical Plan.

You may request a special enrollment more than 120 days following the event and no later than the end of the next Open Enrollment period. When you do so, your new coverage will take effect on the first day of the month after the Fund Office receives your enrollment form.

 

Divorce/Termination of Domestic Partnership or Ineligible Dependent

You must notify the Fund Office immediately of:

  • The date your marriage ends.
  • The date your domestic partnership ends.
  • The date your child(ren) become ineligible for Fund coverage.

If the Fund pays benefits on behalf of your ineligible family members after that date, you will be required to reimburse the Fund for the full amount paid on their behalf.