You or Your Dependent Has a Medicare Coverage Change (Retirees and Survivors Only)

As a retiree, you or a dependent have a change in your Medicare enrollment (for example, you enroll in Parts A and B). This life event does not apply to Active Employees or to Supplemental Benefits.

For Retirees and Survivors

You must enroll in Medicare Parts A and B when you are eligible. Without both Medicare Parts A and B, you are not eligible to enroll in IYC Medicare Advantage. For all other plans, you will be liable for the portion of your claims that Medicare would have paid beginning on the date Medicare coverage would have become effective.

In the table(s) below, supplemental benefits refer to supplemental dental insurance (Select, Select Plus, and Preventive), vision insurance, and Accident Plan. You may not be eligible for all supplemental benefits. Visit the Dental Insurance, Vision Insurance, and Accident Plan pages to learn about eligibility.


	Health Insurance & Uniform Dental	Supplemental Benefits
Enrollment opportunity?	No	No
Change coverage from individual to family?	No	No
Change coverage from family to individual?	Yes	No
Change health plan?	Yes	n/a
Drop a dependent and keep family coverage?	No	No
Cancel coverage?	Yes	No
Deadline to submit application	As soon as possible, file an application with ETF (ET-2331), up to three months in advance of enrollment in Medicare Parts A and/or B. Your new plan will then be effective at the same time as Medicare. You may submit the application up to 30 days after your Medicare effective date, but if you do, the new plan will not be effective coinciding with your Medicare start date. Your new plan will begin the first of the month following receipt of your application by ETF. If you're not sure of your Medicare effective date, you may file your application early and send a copy of your Medicare card later.	n/a
Documentation required?	Yes	n/a
Effective date	Changing to individual coverage: Effective the first of the month following the receipt of the application Changing health plans: Can be effective with Medicare begin date if the application is received by ETF prior to Medicare's begin date. If the application is submitted up to 30 days after Medicare's begin date, plan change will be effective the first of the month following receipt In the rare case that new retirees enroll in Medicare on the first of a month but employment terminates later in the month, the retiree can change health plans one month after Medicare begins Canceling coverage: Effective the last day of the month following receipt of the application	n/a