Cancel Request Reasons and Documentation Requirements

 

1. Marriage – If you are recently married and have become eligible for new spouse’s coverage.

  • Required documentation (all documents must be submitted together within 60 calendar days of marriage date*):
  • End date options (end of month prior to effective date of new coverage)*if request to cancel is outside of 60 days of the new coverage begin date, the coverage may be canceled as of the first of the month following submission of all the proper documents.

 

2. Adoption/placement for adoption – Adopting a child is a Special Qualifying Event (SQE). The employee has the option to cancel their current State Plan coverage to enroll in other coverage due to the adoption. The event date is the date the employee took custody of the child or the date that the child has been “placed” for adoption (i.e., the date the adoption process started for a specific child).

  • Required documentation (all documents must be submitted together within 60 calendar days of the adoption/placement for adoption date*):
  • End date options (end of month prior to effective date of new coverage)*if request to cancel is outside of 60 days of the adoption or placement for adoption date, the coverage may be canceled as of the first of the month following submission of all the proper documents.

 

3. New employment (self or dependents) – If the employee or one or more dependents becomes eligible for new coverage due to obtaining new employment.

  • Required documentation (all documents must be submitted together within 60 calendar days of the new coverage begin date*):
  • End date options (end of month prior to effective date of new coverage)*if request to cancel is outside of 60 days of the new coverage begin date, the coverage may be canceled as of the first of the month following submission of all the proper documents.

 

4. Return from Unpaid leave – A dependent that had taken an unpaid leave of absence from his or her place of employment and was added on to the State Plan coverage as a dependent, may cancel the coverage upon his or her return to work.

  • Required documentation (all documents must be submitted together within 60 calendar days of the new coverage begin date*):
  • End date option (end of month prior to the coverage reinstatement date)

 

5. Entitlement to Medicare, Medicaid or TRICARE - An employee or dependent who is eligible for Medicare, Medicaid or TRICARE coverage may cancel his or her coverage when the new coverage becomes effective. NOTE***An active employee on the State plan does not have to cancel coverage when they become Medicare eligible.***

  • Required documentation (all documents must be submitted together within 60 calendar days of the coverage effective date*):
  • End date options (end of month prior to effective date of new coverage)*if request to cancel is outside of 60 days of the effective date of new coverage, the coverage may be canceled as of the first of the month following submission of all the proper documents.

 

6. Birth – An employee or spouse of employee would like to cancel coverage due to becoming newly eligible on another plan due to the birth of a child. 

  • Required documentation (all documents must be submitted together within 60 calendar days of the birth*):
  • End date options (end of month prior to effective date of new coverage)*if request to cancel is outside of 60 days of the effective date of new coverage, the coverage may be canceled as of the first of the month following submission of all the proper documents.

 

7. Divorce or legal separation- (Note: You cannot remove your spouse from coverage unless your spouse has signed an authorization or the court has given permission). An employee who wishes to remove his or her former spouse from coverage due to divorce. Or, an employee who wishes to cancel coverage due to a divorce and becoming newly eligible for other coverage.

  • Required documentation (all documents must be submitted together within 60 calendar days of the date the divorce was final*).
    • Copy of divorce decree or legal separation paperwork signed by the judge
    • IF EMPLOYEE is canceling coverage only: - Copy of proof of other coverage (on company letterhead that includes date new coverage is effective)
    • Insurance Cancel Request Application - completed in its entirety (parts 1-4) http://www.tn.gov/assets/entities/finance/benefits/attachments/1047.pdf
  • End date options (end of month of that divorce order was finalized)*if request to cancel is outside of 60 days of the finalized date, the coverage may be canceled as of the first of the month following submission of all the proper documents. However, the ex-spouse will not be eligible for COBRA.

 

8. Court decree or order – An employee or dependent needs to be removed from coverage due to a court directive.

  • Required documentation (all documents must be submitted together within 60 calendar days of the date of the court order*).
  • End date options (end of month prior to effective date of new coverage)*if request to cancel is outside of 60 days of the divorce date, the coverage may be canceled as of the first of the month following submission of all the proper documents.

 

9. Open Enrollment An employee or dependent has been enrolled in coverage during the open enrollment (aka Annual Enrollment) of another company and wants to cancel his or her State plan coverage.

  • Required documentation (all documents must be submitted together within 60 calendar days of the effective date of the new coverage*):
  • End date options (end of month prior to effective date of new coverage)*if request to cancel is outside of 60 days of the new coverage begin date, the coverage may be canceled as of the first of the month following submission of all the proper documents.

 

10. Change in place of residence or work out of the national service area (i.e., move out of the U.S.) If an employee or dependent moves out of the United States and wants to cancel coverage.

  • Required documentation (all documents must be submitted together within 60 calendar days of the date the employee or dependent moved out of the country*).
  • End date options (end of month that the employee or dependent moved out of the country)*if request to cancel is outside of 60 days of the employee or dependent moving out of the country, the coverage may be canceled as of the first of the month following submission of all the proper documents.

 

11. Change from part-time to full-time employment (spouse or dependents) – When a spouse or dependent becomes newly eligible for coverage at his or her place of employment because of a status change from part time to full time employee.

  • Required documentation (all documents must be submitted together within 60 calendar days of the date the spouse or dependent’s new coverage effective date*).
  • End date options (end of month prior to effective date of new coverage)*if request to cancel is outside of 60 days of the effective date of new coverage, the coverage may be cancelled as of the first of the month following submission of all the proper documents.

 

12. Marketplace Enrollment – An employee who chooses to enroll in the Federal Marketplace coverage and wants to cancel State plan coverage.

  • Required documentation (all documents must be submitted within 60 calendar days of the date the employee’s new coverage effective date*).
  • End date options (end of month prior to effective date of new coverage)*if request to cancel is outside of 60 days of the effective date of new coverage, the coverage may be canceled as of the first of the month following submission of all the proper documents.
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