Outside of the open enrollment period, changes can only be made to your health, dental and vision insurance plans if you experience a certain "life event."  This rule also applies to the Flexible Spending Accounts and is governed by the IRS. 

  • Request for change must be received within 60 days of the date of the life event. More information about unpaid leave of absence (pdf).
  • Documentation is required.
  • The effective date of the change will be the first of the month following either the receipt of the completed application and required supporting documentation by Employee Health & Wellness or the date of the life event, whichever is later. 
  • Incomplete or illegible applications will be returned and may impact the effective date of the change.
  • Requests have to be consistent with the life event as stated in the "Changes Allowed" column below.

Please note:  If you cancel your entire health insurance contract based on any of the events listed below this may affect your health insurance benefits in retirement. 

If you don't see your particular situation listed below or have any questions, please call Employee Health & Wellness at (207) 624-7380 or 1-800-422-4503.

Printable MS-Word Version effective September 2021

Life Event Documentation Required
Effective 10/1/2016		 Changes Allowed
Marriage of employee Copy of marriage certificate and birth certificate(s) (if adding children). You may add any or all family members.
Marriage of dependent of employee Copy of marriage certificate. Employee may remove that dependent only but no other family members.
Divorce Copy of divorce judgement. It is mandatory to remove your ex-spouse & stepchildren.  It is considered fraud to cover these members on your existing policy after divorce.  Other family members may also be removed.
Domestic partnership:
6-month period met		 Domestic partner affidavit and supporting documents to include birth certificate(s) if applicable.
(See Forms)		 May only add domestic partner and domestic partner's children.
End of domestic partner relationship Employee must submit affidavit of termination of domestic partnership.
(See Forms)		 It is mandatory to remove your domestic partner and the partner's children. Other family members may also be removed.
Dependent child turning 1 year of age (dental only)* Copy of birth certificate if not already on file. You may add your dependent child effective the 1st of the month following the child's 1st birthday*.  This applies to the dental plan only.  The application for change must be received by Employee Health in the month prior to the change. 
*Effective July 1, 2015
Birth of a child Birth certificate for any children you wish to add including newborn and marriage certificate if adding spouse. You may add any family members.
Adoption of a child Copy of court documentation/birth certificate/marriage certificate if adding spouse. You may add any family members.
Death of a spouse, qualified domestic partner or dependent Copy of certified death certificate. You may remove any or all family members.
Involuntary loss of coverage: to include MaineCare, Medicare, employer sponsored coverage* or COBRA (not State of Maine sponsored COBRA) Notice from employer stating insurance end date and reason or plan documents showing end date of coverage and who suffered the loss. You may add any or all family members who suffered the loss of insurance. *Please note: only the loss of employer sponsored coverage applies to retirees.
Medical Support Order by DHHS or National Medical Support Orders Copy of Medical Support Order. Change must be consistent with the order. We will comply with all court orders.
Become eligible for other coverage: to include MaineCare, Medicare, employer sponsored coverage Eligibility notice showing start date of coverage or signed document from employer. You may remove any or all family members effected by the change.
Change in employment status resulting in loss of coverage or gain of coverage (for example: Change in number of hours worked, work assignment ends, start/return from unpaid or seasonal leave of absence, acting capacity status to permanent regular status, etc.) Notice from employer, birth certificate(s) and marriage certificate if applicable. Request must be consistent with the event. For example, if changing from part-time to full-time you may enroll yourself or add family members. However, if you are changing from full-time to part-time you may remove family members or cancel entire contract.
Legal separation The State of Maine does not recognize legal separation. If you reside in another state that recognizes legal separation, please call our office. 1-800-422-4503
Spouse, domestic partner or dependent's annual enrollment Notice from current employer stating insurance end or start date. You may add any or all family members who are effected.
Court order requiring addition or removal of children Copy of court document(s). Change must be consistent with the order to add or remove your dependent(s).
Called for active military service (employee) Signed request to cancel or continue coverage. You may continue coverage for all covered members or just yourself.  You may remove any or all family members or cancel the entire contract.