A special eligibility situation is an event that allows an eligible employee, retiree, survivor or COBRA subscriber to enroll in or drop coverage for himself and/or eligible family members outside an open enrollment period. If this applies to you, to make a change, you must:
Contact your benefits administrator;
Complete the appropriate Notice of Election form within 31 days* of the event; and
Give your benefits administrator copies of the appropriate documents.
*Changes related to Medicaid or the Children’s Health Insurance Program (CHIP), must be made within 60 days.
A salary increase does not create a special eligibility situation.
If you are an active employee and eligible to change your health, Dental/Dental Plus, State Vision Plan or Optional Life Insurance coverage due to a special eligibility situation, you also may enroll in or drop the Pretax Group Insurance Premium Feature.
Please note: Rather than using a paper Notice of Election form, a benefits administrator may make changes electronically and send them to the subscriber through MyBenefits. He must approve and electronically sign the Summary of Change. His benefits administrator also may print a paper Summary of Change for the subscriber to sign. The subscriber should give copies of any required documents to his benefits administrator, who will send them to PEBA.
More details about the following special eligibility situations is located in the General Information chapter of the Insurance Benefits Guide:
Dropping a spouse and/or children
Gaining other coverage (includes gain of Medicare coverage)
Loss of other coverage
Coverage under Medicaid or the Children’s Health Insurance Program (CHIP)