Change occurs in employee's name, address, marital status, or other information. Employee's coverage is cancelled due to enrollment in an alternate health care plan sponsored by the State.
Employee requests termination of coverage.
Enrolled employee or dependent becomes eligible for Medicare. Employee wishes to add or remove a spouse or dependent child. Spouse or dependent child is no longer eligible for coverage. An employee must complete a Change Form within 30 days of an eligibility event to enroll eligible dependents. Effective dates of coverage are subject to plan limitations and the payroll deadline.