Loss of Coverage

Loss of Coverage(Watch video on 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 45 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.

If adding Dependents:

  • Spouse or Partner:
    • Marriage, Civil Union certificate or Domestic Partnership documents and Social Security Number, if not previously submitted to the EUTF
  • Dependent Child:
    • Birth certificate and Social Security Number
    • If enrolling a dependent age 19 through 23 in Dental and/or Vision coverage, student certification from an accredited school/college on school letterhead with registrar’s signature confirming full-time status or an enrollment certificate from the National Student Clearinghouse. Transcripts not accepted.

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. If proof document notification date is outside of the initial 45-day enrollment period, the employee will be given 45 days from the notification date to submit EC-1/EC-1H form and required documents. Those losing coverage from a Medicaid plan have 60 days from event date to submit EC-1/EC-1H form and required documents. The effective date of coverage will be the Event Date.