Gain or Loss of other coverage

Spouse, Domestic Partner or Dependent Child gains other group coverage – you have 31 days to report this QSC

The following changes to your Medical, Dental and Vision enrollment are allowed:

Provided that eligibility was gained under Spouse/Domestic partner’s employer sponsored group medical benefit plan, employee
may opt out.
Employee may waive medical coverage and/or decline dental and/or vision.
Employee may remove individuals who gain other group coverage.
Employee may remove the eligible dependent child that gained other employer sponsored group medical benefit plan.

The following changes to your Optional Life Insurance:

Employee may enroll, increase, decrease, or cancel coverage even when eligibility is not affected.
- Evidence of Insurability (EOI) for Optional Employee Life and/or Optional Spouse/Domestic Partner Life will be required to become insured for more than the Guarantee Issue (GI) amount.

Spouse/Domestic Partner or Child involuntarily loses other group coverage – you have 60 days to report this QSC

The following changes to your Medical, Dental and Vision enrollment are allowed:

Employee may enroll for employee, Spouse/Domestic Partner or eligible children who lose coverage under Spouse/Domestic Partner’s
medical, dental, or vision plans.
Election of coverage may also be extended to previously eligible (but not yet enrolled) children.
The OEBB eligible member may enroll in or switch to any OEBB plans when there is a loss of eligibility under the
Spouse’s or Domestic Partner’s group coverage.

The following changes to your Optional Life Insurance:

Employee may enroll, increase, decrease, or cancel coverage even when eligibility is not affected. Evidence of Insurability (EOI) for Optional Employee Life and/or Optional Spouse/Domestic Partner Life will be required to become insured for more than the Guarantee Issue (GI) amount.

Please complete a 2021-2022 Midyear Change Form and return to HR as soon as possible within the allowed time frame.