Notice Regarding Insurance Coverage of Spouses and Former Spouses
· This document is required by Tennessee Code Annotated 56-7-2366 which requires the “insured or policy holder” of group health insurance coverage to notify the spouse of termination of coverage due to a divorce or separation. That statute is also mentioned in Tennessee Code Annotated section 36-4-133 which requires a court to determine if the appropriate spouse has complied with section 56-7-2366.
· It is the responsibility of the spouse (or that spouse’s attorney) to fill out the form and not the responsibility of Benefits Administration. Benefits Administration staff and Agency Benefits Coordinators (ABC’s) can help the spouse in filling out the form by providing information such as the contact information for COBRA coverage.
· Benefits Administration staff and ABC’s should not fill out or sign the form.
Please see the attached example of notice.
Have more questions? Submit a request