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Reference
Appendix and Legal Notices
“Lost Eligibility for Other Coverage”
means a
loss of other health coverage as a result of your legal
separation or divorce, a dependent’s loss of dependent
status, death, termination of employment or reduction
in number of hours of employment or you no longer
reside, live or work in the service area of a health
maintenance organization in which you participated.
Newly Eligible Dependents
– If you initially
declined enrollment for yourself or your eligible
dependents and you later have a newly eligible
dependent because of marriage, registered domestic
partnership, birth, adoption or placement for
adoption, you may enroll yourself and your newly
eligible dependents (including a previously eligible
dependent spouse, if you have a newly eligible
dependent child) as long as you request enrollment
within 30 days after the marriage, registered
domestic partnership, birth, adoption or placement
for adoption. For example, if you and your previously
eligible dependent spouse have a child, you may
enroll yourself, your previously eligible dependent
spouse and your new child in the medical benefit
option, even if you were not previously enrolled. You
will not, however, be able to enroll existing eligible
dependent children for whom coverage has been
waived in the past.
Your or your eligible dependent’s participation will start
as of the date of the birth, adoption or placement for
adoption, or for marriage/domestic partnership, the
date you submit your election change, so long as you
timely request enrollment. You must provide proof of
your dependent’s status as an eligible dependent.
The change in your benefit contributions will begin on
the first payroll period following your election change
request.
You will need to enroll your new eligible dependents
before the date that is 30 days after the event by
which they became your eligible dependent (for
example, a new spouse, after your marriage or your
baby is born).
• Medicaid and CHIP –
If you or your eligible depen-
dent children are eligible for, but not enrolled in, the
medical benefit option and you or your eligible depen-
dent children:
• Lose coverage under Medicaid or a state child
health plan (“CHIP”) or
• Become eligible for a premium assistance
subsidy through Medicaid or CHIP,
you and your eligible dependent children may enroll in
the medical benefit option as long as you request
enrollment within 60 days after the loss of coverage
or the date you or your eligible dependent children
became eligible for the premium subsidy. You will
need to provide proof of your dependent’s status
as an eligible dependent. Your enrollment will take
effect no later than the date of the loss of coverage or
premium assistance subsidy. The date of the change
in your benefit contributions will begin on the first
payroll period following your election change request.
These 30-day and 60-day periods are “special enrollment periods”.
To request special enrollment or obtain more information, contact:
Benefits Department
Aflac Incorporated
P. O. Box 5248
Columbus, Georgia 31906-0248
(706) 317-0770
