My Spouse, Dependent(s) And/Or I Are No Longer Eligible For Other Coverage

Loss of Other Coverage Due to Your, Your Spouse’s, or Your Dependent’s Loss of Eligibility Under Another Employer’s Health Plan

For health coverage, a loss of eligibility includes exhaustion of COBRA coverage at the end of the maximum COBRA coverage period or the employer terminating a health plan or stopping all contributions to the plan.

Changes must be requested within 31 days of the loss of coverage.

 

Changes are allowed for the following benefits

You can*:

You must provide this supporting documentation:

Health/Rx, Dental, Vision

Enroll or increase coverage for self, spouse and/or child(ren)

Change from one health coverage option to another health coverage option (applies only to health coverage)

Proof of coverage loss

Health Care Flexible Spending Account

Increase or start contributions

Dependent Care Flexible Spending Account

No change allowed

Life/AD&D

No change allowed

Short Term Disability and Long Term Disability, Critical Events, Hospital Indemnity

No change allowed

 


 
Loss of Coverage under Another Employer-Sponsored Plan with a Different Period of Coverage from Mission’s Period of Coverage (the calendar year). Changes must be requested within 31 days of the loss of coverage.

 

Changes are allowed for the following benefits

You can*:

You must provide this supporting documentation:

Health/Rx, Dental, Vision

Enroll for coverage for self, spouse and/or children who were dropped from similar coverage under another employer’s plan Proof of loss of other coverage

Health Care Flexible Spending Account

No change allowed

Dependent Care Flexible Spending Account

Enroll or increase coverage to coordinate with changes under another employer’s plan

Life/AD&D & Dependent Life

Enroll or increase Supplemental Life/AD&D and/or Dependent Life (within limits and providing evidence of insurability)

Short Term Disability and Long Term Disability

Enroll or increase Supplemental STD and/or LTD (within limits and providing evidence of insurability)
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