Type of Change
|
Enrollment Form Needed
|
Transmittal Report Needed
|
Comment/Document
|
|
Address Changes
|
No
|
No
|
Employer or subscriber may call us with this information.
|
|
Adoption
|
Yes
|
No
|
Date placed for adoption.
|
|
Benefit Level---STD
|
Yes
|
No
|
STD Evidence of insurability form for higher benefits.
|
|
Death
|
No
|
Yes
|
Employer or subscriber may call us with this information.
|
|
Dependent Child Changes
|
No
|
No
|
Employer or subscriber may call us with this information.
|
|
Disability
|
No
|
Yes
|
Employer or subscriber may call us to request the initial disability forms for claims.
|
|
Divorce*
|
No
|
No
|
Employer or subscriber may call us with this information.
|
|
Domestic Partner**
|
Yes
|
No
|
Domestic Partner Designee form must be completed.
|
|
Layoff
|
No
|
Yes
|
|
|
Leave of Absence
|
No
|
Yes
|
|
|
Legal Ward
|
Yes
|
No
|
Employer or subscriber to provide copies of legal court documents.
|
|
Loss of Coverage
|
Yes
|
No
|
A Loss of Health Coverage and/or Dental Proof of Loss form must be completed by the employer sponsoring the prior coverage or the prior insurance carrier.
|
|
Marriage
|
Yes
|
No
|
|
|
Medicare Eligibility
|
No
|
Yes
|
Employer or subscriber may send us a copy of the Medicare card.
|
|
Name Change
|
Yes
|
No
|
|
|
Occupation Change
|
Yes
|
Yes
|
An Enrollment Form is necessary if the change in occupation creates eligibility for plan(s).
|
|
Reduction or Increase in Hours Worked
|
No
|
Yes
|
Include new hours and effective date on Transmittal Report.
|
|
Resignation, Nonrenewal, or Discharged Employees
|
No
|
Yes
|
|
|
Retirement***
|
No
|
Yes
|
If the employee was not covered by the WEA Trust prior to retirement, an Enrollment Form is required within 30 days of retirement.
|
|
Salary Level Changes
|
No
|
Yes
|
Disability plan.
|
|
Transfer of Coverage
|
Yes
|
Yes
|
|
|
Waiver of Premium/Changes****
|
No
|
Yes
|
|
* Unless there is a name change, then an Enrollment Form should be completed.
** Applies only to groups with the Domestic Partner Option Benefit Provision.
*** Applies only to groups with Retiree Continuation.
**** Applies only to groups with Waiver of Premium Benefit.