Georgia Health Insurance Coverage Changes

Qualifying Events that Allow Coverage Changes for Active Members

If you are an actively employed Employee and have one of the following qualifying events during the year, you may be able to make a coverage change that is consistent with the event. If you are a Retiree, refer to the Retiree Section for permitted coverage changes. The following chart shows qualifying events and the corresponding changes that active Employees can make.

If you have one of these events:	Within 31 days of event, you may:
Marriage Certified copy of a marriage certificate required	Enroll in coverage Enroll eligible Dependents Discontinue coverage; letter from other plan documenting your coverage is required
Birth, adoption or legal guardianship Copy of certified birth, adoption certificate required, or letter of certification of birth. Copy of court decree showing you financial responsibility for the Dependent and copy of certified birth certificate; and notarized statement that Dependent lives with you in your home on a permanent basis	Enroll in coverage Enroll eligible Dependents Change to any available option
You lose coverage because of divorce Copy of divorce decree and loss-of-coverage documentation required	Enroll in coverage Enroll eligible Dependents Change to family coverage
You, your Spouse, or enrolled Dependent loses or discontinues health benefit coverage through other employment, Medicaid or Medicare Letter from other Employer, Medicaid, or Medicare documenting time and reason for loss of discontinuation required
Your Spouse or your only enrolled Dependent's employment status changes, resulting in a gain of coverage under a qualified plan "Does not include Spouse's open enrollment election" Letter from other Employer documenting affect on coverage eligibility required and who is covered under new plan	Discontinue coverage
Your former Spouse loses coverage or plan is cancelled, resulting in loss of your Dependent child(ren) coverage Letter from other plan documenting loss is required	Enroll eligible Dependent(s) Enroll in coverage
You acquire new coverage under Spouse's Employer's plan Letter from other plan documenting your coverage is required	Change to single coverage Discontinue coverage - you must document your Spouse's coverage and current coverage for all Dependents previously covered by your SHBP coverage
Your Spouse makes an open enrollment change under Spouse's Employer's plan, creating an overlap or break in coverage because Spouse's coverage has a different plan year Letter from other plan documenting overlap or break in coverage is required	Enroll in coverage Enroll eligible Dependent(s) Change to single coverage Discontinue coverage - you must document your Spouse's coverage
You or your Spouse is activated into military services Copy of orders required	Enroll in coverage Change coverage tier
You retire and immediately qualify for a retirement annuity You must complete and submit Plan enrollment form no later than 60 days after leaving active employment	Change coverage tier Change option
You, your Spouse, or all enrolled Dependents become eligible for Medicare or Medicaid Letter from Medicare or Medicaid documenting eligibility required	If no eligible Dependent(s) can discontinue coverage Discontinue your Dependent(s) coverage - if you are retired and you discontinue your SHBP coverage when you enroll for Medicare, you won't be able to enroll again for SHBP coverage Retirees may change to any available option upon becoming eligible for Medicare coverage

When all covered Dependents lose eligibility for coverage, the SHBP will automatically decrease the coverage tier to Employee only under the Participant's current health benefit option. Loss of all Covered Dependents may be through divorce, death, legal separation, an only Covered Dependents exceeding the maximum age of eligibility, an only Covered Dependent no longer meeting full-time student requirements, marriage of an only Covered Dependent child, or a Qualified Medical Child Support Order (QMCSO) requiring a former Spouse to provide health coverage for all covered natural children.

NOTE: Under the Health Insurance Portability and Accountability Act (HIPAA) an employee may be eligible for a special enrollment opportunity if they no longer reside or work in the service area.

Qualified Medical Child Support Orders

If a QMCSO requires:	You can:
You to provide coverage for your natural child(ren)	Enroll change to family coverage - there is no time limit for this change; documentation of the court order and the other coverage is required
Your former spouse to provide coverage for each of your enrolled natural child(ren)	Change from family to single coverage - within 31 days of the court-ordered date; documentation of the court order and the coverage is required

Generally, a change in coverage takes effect the first of the month following receipt of the change request.

Important Note on Coverage Changes:
If your current Plan option is not offered in the upcoming Plan year and you do not elect a different option available to you during open enrollment or the Retiree option change period, your coverage will be transferred automatically to the PPO option, with any applicable surcharge, effective January 1 of the subsequent Plan year.