Code of Massachusetts Regulations › 805 CMR - GROUP INSURANCE COMMISSION › Title 805 CMR 9.00 - ELIGIBILITY AND PARTICIPATION › Section 9.04 - Individual and Family Health Coverage

Current through Register 1525, July 5, 2024
(1) Employees who elect Individual Health
			 Coverage at the time of hire may later elect Family Health Coverage due to a
			 change in family status (
e.g
., marriage or adoption, spouse's
			 loss of other coverage), subject to verifying documentation acceptable to the
			 Commission including, but not limited to, marriage and birth certificates.
			 Verification that requires translation shall be at the applicant's expense. The
			 effective date of the family status change is determined by the
			 Commission.
(2) Employees,
			 Retirees, and Surviving Spouses whose dependents cease to be eligible for
			 Commission coverage must notify the Commission within 30 days of such
			 occurrence. The Commission shall determine the effective date of dependents'
			 coverage termination.
(3) Unless
			 making such a request during the annual open enrollment period, Employees,
			 Retirees, or Surviving Spouses may change their Family Coverage to Individual
			 Coverage only by providing proof of their Dependents' other coverage or a
			 change in family circumstance as described in 805 CMR 9.04. The Commission's
			 decisions relating to coverage termination requests are final and
			 binding.
(4)
Divorce
			 and Remarriage
.
(a) If a former
			 Spouse is eligible under the terms of a divorce decree and enrolled under the
			 insured's family plan, coverage for the former Spouse under the insured's
			 family plan will end upon the remarriage of either the Insured or former
			 Spouse. The former Spouse may be eligible for a divorced Spouse rider or COBRA
			 coverage, as determined by the Commission, depending upon the language in the
			 final divorce decree, separation agreement or court order as
			 applicable.
(b) Former spouses of
			 Employees or Retirees cannot be terminated from Commission health coverage for
			 reasons of additional cost when their children are no longer enrolled in the
			 coverage, unless the divorced Employee or Retiree has remarried or the divorce
			 agreement expressly defines such a scenario as constituting additional
			 cost.
(c) All members are obligated
			 to notify the Commission of divorces and remarriages within 60 days of the
			 event and provide supporting documentation for the event. All members are
			 responsible for updating the Commission's records with all court orders,
			 modifications, and other pertinent information or legal documents surrounding
			 the separation or divorce within 60 days of the event. Failure to timely
			 provide the applicable documentation or address updates may result in
			 termination of Commission coverage, money owed, and/or other
			 consequences.
(d)
1. In the event that a remarriage is not
			 timely reported to the Commission and benefits are provided to an ineligible
			 former Spouse, the Employee may be terminated from Commission coverage until
			 such time as the back premiums or claims expenses are repaid.
2. If an ex-spouse becomes ineligible for
			 coverage under the employee's policy by operation of law, there will be no
			 refund or credits of premiums paid.