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.

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.

For Active Employees

You have a new dependent due to:

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
  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 - 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
  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