EUTF Active – Qualifying Events

The following common qualifying events allow enrollment changes for Actives. To learn more about a specific event, click on the + located on the left of the event. To download a PDF version of these events, click here

Acquisition of Coverage

EVENT DESCRIPTION: Employee gets coverage from another plan and wishes to cancel EUTF plans

WHEN EC-1/EC-1H MUST BE SUBMITTED TO EMPLOYER (Personnel Office): Within 30 days from effective date of gaining coverage elsewhere

DOCUMENTATION REQUIRED TO BE ATTACHED TO EC-1/EC-1H*: Letter from carrier or employer detailing type of coverages enrolled in (i.e., medical, drug, dental, vision), effective date of coverage, and names of covered insured and/or dependents

EFFECTIVE DATE: If coverage is gained 1st of month, EUTF coverage ends day before 1st. If coverage is gained 16th of month, EUTF coverage ends 15th

CHANGES ALLOWED TO PLANS OR TO ENROLL IN PLANS OR ADD DEPENDENTS?: N/A

Birth

EVENT DESCRIPTION: Employee wishes to add newborn to EUTF plans

WHEN EC-1/EC-1H MUST BE SUBMITTED TO EMPLOYER (Personnel Office): Within 180 days from date of birth

DOCUMENTATION REQUIRED*: Birth certificate only if child has a different last name from employee. Social Security Number within 180 days of date of birth.

EFFECTIVE DATE: Employee can choose: birth date, beginning of next pay period after birth date, or beginning of 2nd pay period after birth date

CHANGES ALLOWED TO PLANS OR TO ENROLL IN PLANS OR ADD DEPENDENTS?: No plan changes allowed if already enrolled. May enroll in plans if not already enrolled or may add dependents if already enrolled.

Court Order

EVENT DESCRIPTION: To cover child

WHEN EC-1/EC-1H MUST BE SUBMITTED TO EMPLOYER (Personnel Office): EUTF receives the order directly from the Child Support Enforcement Agency (CSEA). No EC-1/EC-1H is required if employee is already enrolled in EUTF plans

DOCUMENTATION REQUIRED TO BE ATTACHED TO EC-1/EC-1H*: CSEA notice

EFFECTIVE DATE: Effective date on CSEA notice

CHANGES ALLOWED TO PLANS OR TO ENROLL IN PLANS OR ADD DEPENDENTS?: No plan changes allowed if already enrolled. May enroll in plans if not already enrolled or may add dependents if already enrolled.

Death

WHEN EC-1/EC-1H MUST BE SUBMITTED TO EMPLOYER (Personnel Office): As soon as reasonably practical

DOCUMENTATION REQUIRED TO BE ATTACHED TO EC-1/EC-1H*: Death certificate or copy of obituary as soon as available

EFFECTIVE DATE: Date of death or last day of pay period in which date of death occurs for dependents.

CHANGES ALLOWED TO PLANS OR TO ENROLL IN PLANS OR ADD DEPENDENTS?: N/A

Divorce

EVENT DESCRIPTION: Employee must terminate spouse’s or civil union partner’s coverage

WHEN EC-1/EC-1H MUST BE SUBMITTED TO EMPLOYER (Personnel Office): Within 30 days of date of divorce If EC1/EC-1H filed more than 30 days after date of divorce, employee shall be responsible for paying any claims incurred after the date of divorce.

DOCUMENTATION REQUIRED TO BE ATTACHED TO EC-1/EC-1H*: Pages 1 and 2 of divorce decree, along with signature page. If children are involved, those pages that outline health benefits for children

EFFECTIVE DATE: First day of the first pay period following the divorce

CHANGES ALLOWED TO PLANS OR TO ENROLL IN PLANS OR ADD DEPENDENTS?: No

Guardianship

EVENT DESCRIPTION: Employee wishes to add child to EUTF plans

WHEN EC-1/EC-1H MUST BE SUBMITTED TO EMPLOYER (Personnel Office): Within 30 days from date of guardianship

DOCUMENTATION REQUIRED TO BE ATTACHED TO EC-1/EC-1H*: Guardianship decree within 60 days

EFFECTIVE DATE: Employee can choose: Date of guardianship, beginning of next pay period after date of guardianship, or beginning of 2nd pay period after date of guardianship

CHANGES ALLOWED TO PLANS OR TO ENROLL IN PLANS OR ADD DEPENDENTS?: No plan changes allowed if already enrolled. May enroll in plans if not already enrolled or may add dependents if already enrolled.

Leave of Absence Without Pay

EVENT DESCRIPTION: Employee may continue coverage by paying his/her share of premium or terminate coverage

WHEN EC-1/EC-1H MUST BE SUBMITTED TO EMPLOYER (Personnel Office): Within 30 days from beginning of LWOP to waive plans. To reenroll after LWOP EC-1/EC- 1H must be submitted within 30 days of return from LWOP

DOCUMENTATION REQUIRED TO BE ATTACHED TO EC-1/EC-1H*: Form L-1 completed by employer

EFFECTIVE DATE: If employee cancels plans, first day of the pay period following the date LWOP begins

CHANGES ALLOWED TO PLANS OR TO ENROLL IN PLANS OR ADD DEPENDENTS?: No

Legal Separation

EVENT DESCRIPTION: Employee must terminate spouse’s EUTF coverage

WHEN EC-1/EC-1H MUST BE SUBMITTED TO EMPLOYER (Personnel Office): Within 30 days from date of legal separation. If EC-1/EC-1H filed more than 30 days after date of legal separation, employee shall be responsible for paying any claims incurred after the date of legal separation

DOCUMENTATION REQUIRED TO BE ATTACHED TO EC-1/EC-1H*: Court document establishing legal separation, including any pages regarding health benefits to children

EFFECTIVE DATE: First day of the pay period following the legal separation

CHANGES ALLOWED TO PLANS OR TO ENROLL IN PLANS OR ADD DEPENDENTS?: No

Loss of Coverage

EVENT DESCRIPTION: Employee and/or dependent lost coverage from a non-EUTF plan, and wishes to enroll in EUTF plans

WHEN EC-1/EC-1H MUST BE SUBMITTED TO EMPLOYER (Personnel Office): Within 30 days from loss of other coverage

DOCUMENTATION REQUIRED TO BE ATTACHED TO EC-1/EC-1H*: Loss of coverage letter from previous employer/carrier detailing type of coverages lost (i.e., medical, dental, drug, vision), date of loss of coverage, and names of any covered dependents within 60 days

EFFECTIVE DATE: Day following loss of coverage from other plan

CHANGES ALLOWED TO PLANS OR TO ENROLL IN PLANS OR ADD DEPENDENTS?: No plan changes allowed if already enrolled. May enroll in plans if not already enrolled or may add dependents if already enrolled.

Marriage

EVENT DESCRIPTION: Employee wishes to enroll new spouse in EUTF plans

WHEN EC-1/EC-1H MUST BE SUBMITTED TO EMPLOYER (Personnel Office): Within 30 days from date of marriage

DOCUMENTATION REQUIRED TO BE ATTACHED TO EC-1/EC-1H*: Marriage Certificate within 60 days of date of marriage

EFFECTIVE DATE: Employee can choose: Date of marriage, beginning of next pay period after date of marriage or beginning of 2nd pay period after date of marriage

CHANGES ALLOWED TO PLANS OR TO ENROLL IN PLANS OR ADD DEPENDENTS?: No plan changes allowed if already enrolled. May enroll in plans if not already enrolled or may add dependents if already enrolled.

New Civil Union Partner

EVENT DESCRIPTION: Employee wishes to enroll new civil union partner in EUTF plans

WHEN EC-1/EC-1H MUST BE SUBMITTED TO EMPLOYER (Personnel Office): Within 30 days from date of civil union

DOCUMENTATION REQUIRED TO BE ATTACHED TO EC-1/EC-1H*: Civil union certification (on-line proof accepted), Affidavit of Dependency within 60 days of civil union date

EFFECTIVE DATE: Employee can choose: Date of civil union, beginning of next pay period after date of civil union, or beginning of 2nd pay period after date of civil union

CHANGES ALLOWED TO PLANS OR TO ENROLL IN PLANS OR ADD DEPENDENTS?: No plan changes allowed if already enrolled. May enroll in plans if not already enrolled or may add dependents if already enrolled.

New Domestic Partner

EVENT DESCRIPTION: Employee wishes to enroll new domestic partner in EUTF plans

WHEN EC-1/EC-1H MUST BE SUBMITTED TO EMPLOYER (Personnel Office): Within 30 days from date of notarized signature (event date is considered date of notarization)

DOCUMENTATION REQUIRED TO BE ATTACHED TO EC-1/EC-1H*: Notarized Declaration of Domestic Partnership, and Affidavit of Dependency (notarized if IRS qualified) with EC-1 or EC-1H

EFFECTIVE DATE: Employee can choose: Date of notarization of Declaration of Domestic Partnership, beginning of next pay period after notary date, or beginning of 2nd pay period after notary date

CHANGES ALLOWED TO PLANS OR TO ENROLL IN PLANS OR ADD DEPENDENTS?: No plan changes allowed if already enrolled. May enroll in plans if not already enrolled or may add dependents if already enrolled.

New Hire

EVENT DESCRIPTION: New employee wishes to enroll in EUTF plans

WHEN EC-1/EC-1H MUST BE SUBMITTED TO EMPLOYER (Personnel Office): Within 30 days of date of new hire

DOCUMENTATION REQUIRED TO BE ATTACHED TO EC-1/EC-1H*:
1) Student certification on school letterhead with registrar’s signature confirming full-time status if enrolling a dependent age 19 through 23 in dental and/or vision coverage. Transcripts not accepted.
2) Birth certificate if enrolling a dependent with a different last name than the employee.
3) Marriage or civil union certificate.
Employees have 60 days from date of hire to submit proof documents.

EFFECTIVE DATE: Employee can choose: New hire date, beginning of next pay period after
new hire date, or beginning of 2nd pay period after new hire date

CHANGES ALLOWED TO PLANS OR TO ENROLL IN PLANS OR ADD DEPENDENTS?: N/A

Newly Eligible Student

EVENT DESCRIPTION: Employee wishes to add child in dental or vision plan because child became a full time student and is between the ages of 19 through 23

WHEN EC-1/EC-1H MUST BE SUBMITTED TO EMPLOYER (Personnel Office): Within 30 days from date of school start date

DOCUMENTATION REQUIRED TO BE ATTACHED TO EC-1/EC-1H*: Student certification from an accredited school, college or university on school letterhead with registrar’s signature confirming full time status (for dental and vision coverage) within 60 days after becoming a full time student. Transcripts are not acceptable.

EFFECTIVE DATE: Employee can choose: Date child becomes full time student, beginning of next pay period after becoming full time student, or beginning of 2nd pay period after becoming full time student

CHANGES ALLOWED TO PLANS OR TO ENROLL IN PLANS OR ADD DEPENDENTS?: No

Termination of Domestic Partnership

EVENT DESCRIPTION: Employee must terminate domestic partner and domestic partner’s
dependents

WHEN EC-1/EC-1H MUST BE SUBMITTED TO EMPLOYER (Personnel Office): Within 30 days of termination of partnership. If EC-1/EC-1H is filed more than 30 days after date of termination of domestic partnership, employee shall be responsible for paying any claims incurred after the date of termination of domestic partnership

DOCUMENTATION REQUIRED TO BE ATTACHED TO EC-1/EC-1H*: Declaration of Termination of Domestic Partnership With EC-1 or EC-1H

EFFECTIVE DATE: First day of the pay period following the date of the termination of the domestic partnership

CHANGES ALLOWED TO PLANS OR TO ENROLL IN PLANS OR ADD DEPENDENTS?: No