You Have a Job Change Where You Lose a Significant Share of Employer Contribution Toward Your Coverage (Active Employees Only)

For All Programs

As an active employee, you have a decrease of 5% or more in your employer's contribution toward your health insurance. This life event does not apply to retirees or survivors.

For Active Employees

In the table(s) below, supplemental benefits refer to supplemental dental insurance (Select, Select Plus, and Preventive), vision insurance, and Accident Plan. You may not be eligible for all supplemental benefits. Visit the Dental Insurance, Vision Insurance, and Accident Plan pages to learn about eligibility.

There are no employer contributions for supplemental plans, but an increase in health insurance costs reduces net compensation available to pay for supplemental plans.

	Health Insurance & Uniform Dental	Supplemental Benefits
Enrollment opportunity?	No	No
Change coverage from individual to family?	No	No
Change coverage from family to individual?	Yes	Yes
Change health plan?	Yes	n/a
Drop a dependent and keep family coverage?	No	No
Cancel coverage?	Yes	Yes
Deadline to submit changes	Within 30 days of decrease in employer contribution	Within 30 days of decrease in employer contribution
How to submit changes	Submit the Health Insurance Application/Change Form (ET-2301) to your employer	Submit the Supplemental Insurance Application/Change (ET-2339) to your employer
Documentation required?	No	No
Effective date	Coverage changes become effective on the first of the month following date of position change, unless change date is the first of the month, then coverage is effective the first of the month Canceling coverage: This coverage ends the end of the month following receipt of application	Coverage changes become effective on the first of the month following date of position change, unless change date is the first of the month, then coverage is effective the first of the month Canceling coverage: This coverage ends the end of the month following receipt of application