Loss of Coverage

EVENT DESCRIPTION: Retiree and/or dependent lost coverage from a non-EUTF plan, wishes to enroll in EUTF or HSTA VB plans, and for dependents the retiree is currently enrolled in an EUTF or HSTA VB plan

WHEN EC-2/EC-2H MUST BE SUBMITTED TO EUTF: Within 45 days from loss of other coverage

DOCUMENTATION REQUIRED TO BE ATTACHED TO EC-2/EC-2H: Loss of coverage letter from previous employer/carrier detailing type of coverages lost (i.e., medical, drug, dental, vision), date of loss of coverage, and names of any covered dependents.

Copy of dependent’s Medicare card showing Part B and letter from Social Security for retiree’s spouse or partner, if eligible to enroll. DDA form if retiree is not Medicare eligible yet.

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, 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

CAN I CHANGE PLANS?: No plan changes allowed if already enrolled. May enroll in plans if not already enrolled or may add dependents if already enrolled.