Enrollment

To receive benefits, you must complete an enrollment form for yourself and all your eligible Dependents and submit copies of the documentation listed below. (You should fill out the form prior to the completion of your hours-of-service requirement for initial eligibility).

Spouse Marriage certificate
Domestic Partner California Domestic Partner registration form or equivalent for other jurisdictions (see below)
Dependent Children Birth certificate, adoption papers, or Qualified Medical Child Support Order (see below)

Once enrolled coverage is retroactive to the date of eligibility. HOWEVER; Kaiser limits retroactive coverage to 60 days. The Plan will not provide coverage earlier than the carrier allows. Therefore, be sure to complete enrollment within 60 days to make sure you are covered from the date you and/or your dependent is first eligible.

Rolling Enrollment

You will be given the opportunity to change your benefit program selection(s) one time in any given 12-month period provided you have maintained enrollment in your current selection for at least twelve months. All of your Dependents are covered in the same option you choose for yourself, if they are properly enrolled in the Plan. Rolling enrollment does not apply to those who have not satisfied the 18 or 36-month waiting periods described in Employee Eligibility.

Changes in Family Status

If you have a change in family status during the year (such as marriage, divorce, legal separation, starting or terminating a domestic partnership, birth or adoption of a child or death of any Dependent) or you lose coverage under your spouse’s or domestic partner’s plan, or a Dependent or domestic partner currently not enrolled loses other insurance coverage, you will be allowed to revise your coverage option, provided you notify the Fund Office within 30 days of the change. This change will be effective the first day of the month following the status change (except newborns who are effective the date of birth).

If you are enrolled in the Kaiser medical plan or the UnitedHealthcare dental plan and you move out of the Kaiser or UnitedHealthcare service area, you can request that you and your Dependents change medical or dental plans, provided you notify the Fund Office within 30 days of the date you change your residence. Your new plan will be effective on the first day of the calendar month following the month that the Fund Office receives your new enrollment form.

To make changes to your coverage, obtain a new enrollment form and return it to the Fund Office with appropriate documents.

Special Enrollment Rights Under SCHIP and Medicaid

You and your Dependents may also enroll in this Plan if you (or your Dependents) have coverage through Medicaid or a State Children’s Health Insurance Program (SCHIP) and you (or your Dependents) lose eligibility for that coverage. However, you must request enrollment within 60 days after the Medicaid or SCHIP coverage ends.

You and your Dependents may also enroll in this Plan if you (or your Dependents) become eligible for a premium assistance program through Medicaid or a State Children’s Health Insurance Program (SCHIP). However, you must request enrollment within 60 days after you (or your Dependents) are determined to be eligible for such assistance.