WHEN YOUR LIFE CHANGES BECAUSE OF

marriage,
dependent's (including spouse's) loss of previous coverage,
birth of a child,
adoption,
appointment as legal guardian,
death,
divorce,
legal separation,
loss of dependent status

PLEASE, PLEASE, PLEASE LET US KNOW

718-291-3434

You must notify the Fund Office within 60 days of the event.

This only applies when your employer's contract includes coverage for dependents. Without giving 60 days written notice and sending the appropriate documents to the Fund Office, enrollment may be delayed until the Open Enrollment Period (the anniversary month of your employer's contract).

You are also entitled to an additional special enrollment right if (i) you or your dependent is covered under Medicaid or the Children's Health Insurance Program ("CHIP") and such coverage is terminated, or (ii) you or your dependent becomes eligible for a state subsidy for enrollment in the Fund under Medicaid or CHIP, provided that you request coverage under the Fund within sixty (60) days after such termination or eligibility.