This Life Events Guide page has two sections - active employees and retirees. Please refer to the appropriate page section for information based on your employment status. This life event does not apply to survivors.
For Active Employees
You have a new dependent due to:
- Birth, Adoption, or Placement for Adoption
- National Medical Support Notice
- Paternity
- Legal Guardianship
- Transfer of Custody
Birth, Adoption, or Placement for Adoption - Active Employees
Health Insurance & Uniform Dental | Supplemental Benefits | |
---|---|---|
Enrollment opportunity? |
Yes, also includes birth of grandchild from your covered dependent under age 18 (Your grandchild becomes ineligible at the end of the month in which the parent, your dependent, turns age 18) |
Yes |
Change coverage from individual to family? | Yes | Yes |
Change coverage from family to individual? | No | No |
Change health plan? | Yes | n/a |
Drop a dependent and keep family coverage? | No | No |
Cancel coverage? | Yes | Yes |
Deadline to submit application |
To enroll: File an application with your employer within 60 days of the event To change or cancel: File an application with your employer within 30 days of the event |
To enroll: File an application with your employer within 60 days of the event To change or cancel: File an application with your employer within 30 days of the event |
Documentation required? | Yes | Upon request |
Effective date |
New coverage is effective on the date of the event For a plan change, coverage is effective the first of the month following the receipt of the application If approved to cancel, coverage will end the last day of the month after your other coverage begins |
New coverage is effective on the date of the event For a plan change, coverage is effective the first of the month following the receipt of the application If approved to cancel, coverage will end the last day of the month after your other coverage begins |
National Medical Support Notice (NMSN) - Active Employees
Health Insurance & Uniform Dental | Supplemental Benefits | |
---|---|---|
Enrollment opportunity? | Yes | Yes |
Change coverage from individual to family? | Yes | Yes |
Change coverage from family to individual? | No | No |
Change health plan? | Yes | n/a |
Drop a dependent and keep family coverage? | No | No |
Cancel coverage? | Yes | Yes |
Deadline to submit application | To enroll: File an application with your employer within 60 days of the event To change or cancel: File an application with your employer within 30 days of the event |
To enroll: File an application with your employer within 60 days of the event To change or cancel: File an application with your employer within 30 days of the event |
Documentation required? |
Yes | Upon request |
Effective date |
New coverage is effective on the first of the month on or after receipt of the application, or the date specified on the NMSN, if one is specified For a plan change, coverage is effective the first of the month following the receipt of the application If approved for cancellation, coverage will end the last day of the month after your other coverage begins |
New coverage is effective on the first of the month on or after receipt of the application, or the date specified on the NMSN, if one is specified For a plan change, coverage is effective the first of the month following the receipt of the application If approved for cancellation, coverage will end the last day of the month after your other coverage begins |
Paternity - Active Employees
Health Insurance & Uniform Dental | Supplemental Benefits | |
---|---|---|
Enrollment opportunity? | Yes | Yes |
Change coverage from individual to family? | Yes | Yes |
Change coverage from family to individual? | No | No |
Change health plan? | Yes | n/a |
Drop a dependent and keep family coverage? | No | No |
Cancel coverage? | Yes | Yes |
Deadline to submit application | To enroll: File an application with your employer within 60 days of the event. Children born outside of marriage become dependents of the father on the date of the court order declaring paternity, on the date the acknowledgment of paternity is filed with the Department of Health Services (or equivalent if the birth was outside of the state of Wisconsin), or on the date of birth with a birth certificate listing the father's name To cancel or change: File an application with your employer within 30 days of the event |
To enroll: File an application with your employer within 60 days of the event To cancel or change: File an application with your employer within 30 days of the event |
Documentation required? | Yes | Upon request |
Effective date |
Birth certificate or statement of paternity is filed within 60 days of birth: Coverage is effective on date of birth Application is filed more than 60 days after birth, without a birth certificate: Coverage is effective on the first of the month following the receipt of application Cancellation: If approved for cancellation, coverage will end the last day of the month after your other coverage begins |
Birth certificate or statement of paternity is filed within 60 days of birth: Coverage is effective on date of birth Application is filed more than 60 days after birth, without a birth certificate: Coverage is effective on the first of the month following the receipt of application Cancellation: If approved for cancellation, coverage will end the last day of the month after your other coverage begins |
Legal Guardianship - Active Employees
Health Insurance & Uniform Dental | Supplemental Benefits | |
---|---|---|
Enrollment opportunity? | Yes | Yes |
Change coverage from individual to family? | Yes | Yes |
Change coverage from family to individual? | No | No |
Change health plan? | Yes | n/a |
Drop a dependent and keep family coverage? | No | No |
Cancel coverage? | Yes | Yes |
Deadline to submit application | To enroll: File an application with your employer within 60 days of the event To change or cancel: File an application with your employer within 30 days of the event |
To enroll: File an application with your employer within 60 days of the event To change or cancel: File an application with your employer within 30 days of the event |
Documentation required? | Yes | Upon request |
Effective date |
New coverage is effective on the date of the event For a plan change, coverage is effective the first of the month following the receipt of the application If approved for cancellation, coverage will end the last day of the month after your other coverage begins |
New coverage is effective on the date of the event For a plan change, coverage is effective the first of the month following the receipt of the application If approved for cancellation, coverage will end the last day of the month after your other coverage begins |
Custody Transfer - Active Employees
Health Insurance & Uniform Dental | Supplemental Benefits | |
---|---|---|
Enrollment opportunity? | Yes | Yes |
Change coverage from individual to family? | Yes | Yes |
Change coverage from family to individual? | No | No |
Change health plan? | Yes | n/a |
Drop a dependent and keep family coverage? | No | No |
Cancel coverage? | Yes | Yes |
Deadline to submit application | File an application with your employer within 30 days of the event | File an application with your employer within 30 days of the event |
Documentation required? | Yes | Upon request |
Effective date |
New coverage is effective on the date of the event For a plan change, coverage is effective the first of the month following the receipt of the application If approved for cancellation, coverage will end the last day of the month after your other coverage begins |
New coverage is effective on the date of the event For a plan change, coverage is effective the first of the month following the receipt of the application If approved for cancellation, coverage will end the last day of the month after your other coverage begins |
For Retirees
You have a new dependent due to:
- Birth, Adoption, or Placement for Adoption
- National Medical Support Notice
- Paternity
- Legal Guardianship
- Transfer of Custody
Birth, Adoption, or Placement for Adoption - Retirees
Health Insurance & Uniform Dental | Supplemental Benefits | |
---|---|---|
Enrollment opportunity? |
No |
Yes |
Change coverage from individual to family? | Yes | Yes |
Change coverage from family to individual? | Yes | No |
Change health plan? | Yes | n/a |
Drop a dependent and keep family coverage? | No | No |
Cancel coverage? | Yes | Yes |
Deadline to submit application |
To enroll: File an application with the Department of Employee Trust Funds (ET-2331) within 60 days of the event To change or cancel: File an application with ETF (ET-2331) within 30 days of the event |
To enroll: File an application with the vendor within 60 days of the event To change or cancel: File an application with the vendor within 30 days of the event |
Documentation required? | Yes | Upon request |
Effective date |
New coverage is effective on the date of the event For a plan change, coverage is effective the first of the month following the receipt of the application If approved for cancellation, coverage will end the last day of the month after your other coverage begins |
New coverage is effective on the date of the event For a plan change, coverage is effective the first of the month following the receipt of the application If approved for cancellation, coverage will end the last day of the month after your other coverage begins |
National Medical Support Notice (NMSN) - Retirees
Health Insurance & Uniform Dental | Supplemental Benefits | |
---|---|---|
Enrollment opportunity? | No | Yes |
Change coverage from individual to family? | Yes | Yes |
Change coverage from family to individual? | Yes | No |
Change health plan? | Yes | n/a |
Drop a dependent and keep family coverage? | No | No |
Cancel coverage? | Yes | Yes |
Deadline to submit application | To enroll: File an application with ETF (ET-2331) within 60 days of the event To change or cancel: File an application with ETF (ET-2331) within 30 days of the event |
To enroll: File an application with the vendor within 60 days of the event To change or cancel: File an application with the vendor within 30 days of the event |
Documentation required? |
Yes |
Upon request |
Effective date |
New coverage is effective on the first of the month on or after receipt of the application, or the date specified on the NMSN, if one is specified For a plan change, coverage is effective the first of the month following the receipt of the application If approved for cancellation, coverage will end the last day of the month after your other coverage begins |
New coverage is effective on the first of the month on or after receipt of the application, or the date specified on the NMSN, if one is specified For a plan change, coverage is effective the first of the month following the receipt of the application If approved for cancellation, coverage will end the last day of the month after your other coverage begins |
Paternity - Retirees
Health Insurance & Uniform Dental | Supplemental Benefits | |
---|---|---|
Enrollment opportunity? | No | Yes |
Change coverage from individual to family? | Yes | Yes |
Change coverage from family to individual? | Yes | No |
Change health plan? | Yes | n/a |
Drop a dependent and keep family coverage? | No | No |
Cancel coverage? | Yes | Yes |
Deadline to submit application | To enroll: File an application with ETF (ET-2331) within 60 days of the event. Children born outside of marriage become dependents of the father on the date of the court order declaring paternity, on the date the acknowledgment of paternity is filed with the Department of Health Services (or equivalent if the birth was outside of the state of Wisconsin), or on the date of birth with a birth certificate listing the father's name To cancel or change: File an application with ETF (ET-2331) within 30 days of the event |
To enroll: File an application with the vendor within 60 days of the event To cancel or change: File an application with the vendor within 30 days of the event |
Documentation required? | Yes | Upon request |
Effective date |
Birth certificate or statement of paternity is filed within 60 days of birth: Coverage is effective on date of birth Application is filed more than 60 days after birth, without a birth certificate: Coverage is effective on the first of the month following the receipt of application Cancellation: If approved for cancellation, coverage will end the last day of the month after your other coverage begins |
Birth certificate or statement of paternity is filed within 60 days of birth: Coverage is effective on date of birth Application is filed more than 60 days after birth, without a birth certificate: Coverage is effective on the first of the month following the receipt of application Cancellation: If approved for cancellation, coverage will end the last day of the month after your other coverage begins |
Legal Guardianship - Retirees
Health Insurance & Uniform Dental | Supplemental Benefits | |
---|---|---|
Enrollment opportunity? | No | Yes |
Change coverage from individual to family? | Yes | Yes |
Change coverage from family to individual? | Yes | No |
Change health plan? | Yes | n/a |
Drop a dependent and keep family coverage? | No | No |
Cancel coverage? | Yes | Yes |
Deadline to submit application | To enroll: File an application with ETF (ET-2331) within 60 days of the event To change or cancel: File an application with ETF (ET-2331) within 30 days of the event |
To enroll: File an application with the vendor within 60 days of the event To change or cancel: File an application with the vendor within 30 days of the event |
Documentation required? | Yes | Upon request |
Effective date |
New coverage is effective on the date of the event For a plan change, coverage is effective the first of the month following the receipt of the application If approved for cancellation, coverage will end the last day of the month after your other coverage begins |
New coverage is effective on the date of the event For a plan change, coverage is effective the first of the month following the receipt of the application If approved for cancellation, coverage will end the last day of the month after your other coverage begins |
Custody Transfer - Retirees
Health Insurance & Uniform Dental | Supplemental Benefits | |
---|---|---|
Enrollment opportunity? | No | Yes |
Change coverage from individual to family? | Yes | Yes |
Change coverage from family to individual? | Yes | No |
Change health plan? | Yes | n/a |
Drop a dependent and keep family coverage? | No | No |
Cancel coverage? | Yes | Yes |
Deadline to submit application | File an application with ETF (ET-2331) within 30 days of the event | File an application with the vendor within 30 days of the event |
Documentation required? | Yes | Upon request |
Effective date |
New coverage is effective on the date of the event For a plan change, coverage is effective the first of the month following the receipt of the application If approved for cancellation, coverage will end the last day of the month after your other coverage begins |
New coverage is effective on the date of the event For a plan change, coverage is effective the first of the month following the receipt of the application If approved for cancellation, coverage will end the last day of the month after your other coverage begins |