Loss of Spousal Coverage

If health and dental benefits are initially waived by a Plan Member because he or she had comparable coverage under a spousal plan, and his or her spouse subsequently loses coverage, the Plan Member has 31 days in which to apply for benefits under your program. If application is not made within 31 days, he or she would then be considered a “late applicant” and would have to submit Evidence of Insurability before the insurer would accept the Plan Member onto the plan.

Within 31 days:

1. Plan Administrator completes Sections 1 and 3 to of the Change Form by indicating the Plan Member's identification number, name, effective date of change etc.
2. Plan Member completes Sections 2 11 and 13 the Change Form
3. Fax or scan and email a copy of this form to the Morneau Shepell office
4. Retain the original for your files

After 31 days:

1. Plan Administrator completes Sections 1 and 3 to of the Change Form by indicating the Plan Member's identification number, name, effective date of change etc.
2. Plan Member completes Sections 2 11 and 13 the Change Form
3. Have the Plan Member complete the Great-West Life’s Evidence of Insurability form

Submit the original signed Evidence of Insurability Form to Great-West Life.

Note: The Plan Member does not have coverage until they receive confirmation from Great-West Life. They will receive a letter advising them of the insurance company’s decision (approval or declination).

Please provide the Plan Member with a Member Booklet.