Family Coverage for 2024-25 form
Please fill out the above form if there is a change in status.
You must provide your change of status within 60 days of having a baby, getting married, etc. or your new family members risk never receiving Catastrophic Major Medical benefits.
Did you get married, have a baby, get divorced, or change your family status in any way? We need to know.
In order for you and your family to receive the benefits to which you are entitled, you must inform us of any changes. Children who have reached their nineteenth birthday are no longer eligible for benefits unless they are full-time college students. The coverage for these students ends on their twenty-fifth birthday. Please keep in mind that this date is different than the date contained in the new health insurance law.