X hits on this document





59 / 113

Open Enrollment Retirees cannot add dependents during open enrollment. A non-Medicare eligible retiree/surviving spouse may choose either Base Coverage or Select Coverage during open enrollment. A retiree/surviving spouse may also apply for High Option for Children at this time, if covering dependents under the age of 18.

Special Enrollment Periods resulting from loss of coverage A dependent of a covered retiree/surviving spouse who loses coverage under another health plan will be eligible to enroll for coverage in the Plan if the following apply:

  • The retiree/surviving spouse declined coverage for his dependents when first eligible because the dependent was covered by other health insurance coverage; and

  • The dependent lost other coverage as a result of any of the following qualifying events:

    • Divorce.

    • The dependent is no longer eligible for coverage. (Loss of coverage due to non-payment of premiums does not qualify.)

    • The employer ceased to contribute toward the cost of the other health plan, and it was terminated.

    • The dependent’s COBRA continuation has run out.

To enroll for coverage under these circumstances, an Application for Coverage form must be submitted within 31 days of losing coverage under the other plan and appropriate premium payments must be made. As part of the application process, proof of loss of coverage must be provided. If these requirements are met, coverage under the Plan will take effect the first day following the loss of other coverage.

The enrollee may also apply for High Option for Children for eligible dependent children (up to age 18) during this special enrollment period.

Special Enrollment Period as a result of gaining a new dependent A retiree/surviving spouse may enroll a new dependent if the new dependent was acquired as a result of any of the following qualifying events:

  • Marriage,

  • Birth,

  • Adoption, or placement in anticipation of adoption,

  • Legal guardianship,

  • Legal custody, or

  • Qualified Medical Child Support Order

To enroll the new dependent, an Application for Coverage form must be submitted to Blue Cross & Blue Shield within 31 days of the date of the qualifying event and the appropriate premiums must be paid. Any Application for Coverage form received by Blue Cross & Blue Shield more


Document info
Document views363
Page views363
Page last viewedThu Jan 19 17:12:23 UTC 2017