Permanent Intermittent Enrollment/Cancelation Permitting Permitting Event Effective Date of Permitting Event Time Limit to File Document Event Code Date Action New enrollment. 04 June 30 or First of the month 60 days from the end of the December 31 after the STD. 692 control period is received by the employing department. (NOTE: Effective date can be no earlier than February 1 or August 1) Employee Appointed P.I. reinstatement from 04a Date of of the month 60 days from reinstatement retirement to active P.I. employment status. reinstatement from following date retirement reinstatement date Cancellation due to loss of eligibility. 39 June 30 or August 1 or 60 days from the event (eligible December 31 February 1 for COBRA) Dental Program Miscellaneous Enrollment and Deletion Permitting Permitting Effective Date of Permitting Event Time Limit to File Document Event Code Date Action Deleting all family members (no reason for 25 Date STD. 692 Standard (*) No time request needed) on a current basis only. signed Employee and/or dependent enrolled but not 42 Date of original Date of original No time limit eligible or dual and/or split coverage exists. enrollment or dual enrollment or dual and/or split and/or coverage began coverage (**) Newly hired eligible employees terminated due 01a Date of rehire Standard 60 Days from rehire date to layoff then re-hired within 36 months under stated policy conditions.
Permanent Intermittent Enrollment/Cancelation Permitting Event Permitting Event Code Permitting Event Date Effective Date of Action Time Limit to File Document New enrollment. 04 June 30 or December 31 First of the month after the STD. 692 is received by the employing department. (NOTE: Effective date can be no earlier than February 1 or August 1) 60 days from the end of the control period Employee Appointed P.I. reinstatement from retirement to active P.I. employment status. 04a Date of reinstatement from retirement of the month following reinstatement date 60 days from reinstatement date Cancellation due to loss of eligibility. 39 June 30 or December 31 August 1 or February 1 60 days from the event (eligible for COBRA) Dental Program Miscellaneous Enrollment and Deletion Permitting Event Permitting Event Code Permitting Date Effective Date of Action Time Limit to File Document Deleting all family members (no reason for request needed) on a current basis only. 25 Date STD. 692 signed Standard (*) No time Employee and/or dependent enrolled but not eligible or dual and/or split coverage exists. 42 Date of original enrollment or dual and/or split coverage began Date of original enrollment or dual and/or coverage (**) No time limit Newly hired eligible employees terminated due to layoff then re-hired within 36 months under stated policy conditions. 01a Date of rehire Standard 60 Days from rehire date