To change your health coverage you must always contact your local School District’s Health Plan Representative ON A TIMELY BASIS (USUALLY WITHIN 30 DAYS) and complete the necessary forms. All relevant supporting documentation must be submitted; otherwise the District Representative cannot authorize the change of coverage form, as required by the Plan.
Documentation Required
The following supporting documentation must be furnished ON A TIMELY BASIS (USUALLY WITHIN 30 DAYS) to the local School District’s Health Plan Representative in the event of:
Event Documents
Marriage: Marriage certificate
Divorce: Divorce decree (sections regarding Health Coverage and date of court order)
Separation: Court recorded legal separation papers
Birth: Birth certificate
Adoption: Initial letter from adoption agency, then the final papers from the court, when available.
Addition of Child(ren): Court order, Proof of Residency and Financial Dependence upon member.
Dependent Child(ren):
A. Loss of Covered Dependent Status at age 19: Written advisory letter (from member) or completion of appropriate School District’s Health Plan form(s).
B. Continuation of coverage while full-time student, ages 19 through 24: Certification of Enrollment from qualified full-time school; updated twice yearly, Winter and Summer.
C. Loss of Covered Student Status for any reason, ages 19 through 24: Written advisory letter from member/student or completion of appropriate School District’s Health Plan form(s).
Death: Death Certificate – Termination of Copy of HIPAA certificate(s), or letter from former other Coverage: employer, or other documentation from prior health insurance carrier.
Failure to submit the proper documentation can result in the delay and/or denial of Plan coverage or of COBRA eligibility. Therefore, it is to your advantage to notify your School District immediately upon a change in your family’s status.
If you have questions, please refer to the “Definition of a Dependent” and the Sections on “Eligibility” and “Termination” of the Plan’s Certificate of Coverage on the website, or contact your local School District’s Health Plan Representative.
