Adding Dependents
(Spouse, Domestic partner, Children)
Qualifying events:
The following events allow dependents to be added to your health benefits:
- Birth of a child
- Marriage
- Adoption/Pre-Adoption placement
- Court-ordered Custody
- Medical Child Support order
- Legal Guardianship
- Loss of other group medical coverage
- Major adverse change in other coverage
- Declaration of Domestic Partnership
After your initial 31 days of hire, you have 63 days from the date of the qualifying event (on births and adoptions the 63 days begin after the 31 days of automatic coverage) to enroll additional members to your health plan. Your enrollment/change form and any required documentation (such as a birth certificate or marriage license) MUST be received by the 63rd day at:
PO Box 200130
Helena, MT 59620-0130
Effective Dates for New Dependents
Dependent coverage for newly added dependents will be effective on the first day of the pay period following the date the paperwork is recieved - except for the following:
- Birth and child support orders are effective on the date of the event.
- Adoptions - the employee can choose either the date of the event or the first day of the next pay period.
Removing Dependents
Qualifying events:
The following events result in loss of your dependent's eligibility for State employee benefits:
- Divorce
- Legal Separation
- Dissolution of a domestic partner relationship
- Death
- Dependent child reaching age 26 (enrollment/change form is NOT required)
In addition, if your spouse or child becomes eligible for other insurance due to a job change, you have the option to remove them from your coverage. Your spouse or child will not lose eligibility for State employee benefits; however, it does provide you the opportunity to remove them from coverage. Remember that if a dependent is removed, they can only be added back on due to a qualifying event.
Termination Effective Dates
Dependent termination effective dates are as follows:
- The ineligible dependent(s) will only be covered through the end of the month in which the event occurs.
- In the event that your spouse or child becomes eligible for other insurance due to a job change and you request that they be removed from your plan, your spouse or child will only be covered through the end of the pay period in which the other coverage becomes effective.
For members on the Premium Payment Plan - there will be NO refunds for premiums paid beyond the period in which the ineligible dependent is covered and all claims paid after the dependent's termination date will be reversed. Members removing ineligible dependents need to complete the Enrollment/Change Form as soon as possible (except for cases where the dependent turns 26, these dependents will be removed automatically) and return it to:
PO Box 200130
Helena, MT 59620-0130
For complete information regarding Qualifying Events, please refer to the Summary Plan Document.
If you have received a letter of denial after you have turned in the enrollment/change form and you do not agree with the decision, you have the option to appeal. If you wish to appeal the decision you must send in a written request within 30 days from the date of the denial letter you received. The appeal should indicate the reasons you feel this decision should be re-evaluated. All information that you provide will be reviewed and a final decision issued within 45 days from the date that we receive your appeal in our office.
The request should be sent to:
Health Care and Benefits Division
Attn: Appeals
PO Box 200130
Helena, MT 59620-0130
