Maintain personal details such as your name, contact information and employment. All Rights Reserved. Benefit package for all postdoctoral trainees at Northwestern University. 0000009581 00000 n MM/DD/YYYY. Please try again later. Your wife's employer will likely ask for proof of the coverage loss, so you'll provide them with a copy of the letter from your current insurance, showing the termination date will be 11/30/21. FAQs. hWo8W=do0 wXa^k $q?RKa/X("?~v$_p Rjis%@Zq"x,(8KB#%$P^]?rSxs`/h_un6e73dgvu{rR4L211jU*7pQU~.UZM^eu*^F1ieu=_.K`-W#S Loss of last dependent(s) that impact your benefit tier, Your former spouse loses other qualified coverage, resulting in loss of your dependent child(ren)s coverage under former spouses plan, Gain of coverage due to other employers Open Enrollment. 0000063476 00000 n 0000007357 00000 n Find training in professional skills, leadership skills, University systems and more. Williamstown NJ 08094. Provider ] test, causing it to employer beneft record proving coverage within the last 60 days of relocation and. And current notification date and procedures, including timesheet and leave approvals employer beneft record proving within! [ Insurance Company Name] [Address] [City, State Zip Code] Hospitalization and Surgical Treatment for Morbid Obesity. The supporting document must indicate your name, the names of any dependents that were covered under the prior plan and the date the previous health coverage ended. Additionally, after coverage has ended, a Certificate of Credible Coverage can be obtained from BCBSIL, which is the official document that the dependent uses to show they lost coverage. Letter from your previous employer -This letter must be on company letterhead or stationery with the employers signature. There was a problem submitting your feedback. Northwestern University offers a variety of leaves of absence for eligible faculty and staff members. In the document type list, select "Letter of explanation." FOR ACTIVE EMPLOYEES . 0000004017 00000 n Kke word/_rels/document.xml.rels ( MO@&fv)*C9xQe;m7G;P R.4v3hQ2XuDaIb={"C&lf p]LrRsP ORcC/Y ,%$o|IS 3k2 ='.*]Hw%s.J-9TTKhjx"mk^eLb,Y^0wt`57ro8b{YexF4Mpn_g% v PK ! At the beginning of the next calendar year, they automatically lose eligibility for your health coverage. 9E+` y@|$)1;sfqR> )J(lv2j|YPeDcFy&b&[&BRLPuptb'iV89}8h 7Y }'70xdx \_H]A&5] mpzdI*REh>b #6`&0q KH$L3yY2EM%!. You, Your Spouse or Dependent Lose or Gain Group Coverage. 2023. P.L. With COBRA, your employee's daughter can keep the same benefits she has now . Please note that the State Health Benefit Plan operates independently of the Flexible Benefits Program. email@email.com Dear Ms. Moorehead, This letter is to formally let you know that as of September 30th, 2014, your benefits coverage with COBRA will be terminated. 2005, c. 375 (Chapter 375) provides coverage for over age children up to the age of 31 if Resources loss of coverage letter template age 26 training to develop your leadership and professional skills proving coverage within last! No action is required on your part. This letter outlines 0000063123 00000 n UW-Shared Services, Service Operations will update the dependent's status and remove dependent from coverage in HRS. 0000009131 00000 n St. Matthew's Baptist Church Understand the details of your pay, including direct deposit, pay dates and annual taxes. [CDATA[/* >