If you have recently adopted, been given an intent to adopt document or awarded legal custody of a child, an application to add the newly acquired dependent must be submitted to Benefits Administration within 30 days of the acquire date.
To add a newly acquired dependent to your State Group Health Insurance coverage, fill out an Enrollment Change Application. Go to the web page below and click on Forms to locate the Enrollment Change Application.
You are also required to submit a copy of the court order, intent to adopt document or the adoption document along with the Enrollment Change Application to your agency benefits coordinator (ABC).
The child’s coverage will be effective on the date of the respective document.
Your ABC will review the documents, sign the Enrollment Change Application and submit it to Benefits Administration for final approval.
NOTE: The State Group Health Insurance Plan does not prorate premiums. If the effective date due to adoption or legal custody is a date other than the first of the month, you will be required to pay the premium for the entire month.