BenXcel Qualifying Event Name
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Required Documentation
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| 1. Birth of a Baby, Adoption of a Child or New Legal Guardianship |
- Birth Certificate, Adoption Paperwork or Court Documents
- Social Security Number added by employee (within 60 days)
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2. Marriage or Domestic Partnership
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- Marriage Certificate or Domestic Partnership Affidavit
- Birth Certificates for Step Children
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| 3. Divorce |
- Divorce Decree or Legal Separation
- Termination of Domestic Partnership
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4. Drop Self and Dependents from Medical due to New Eligibility for Other Group Coverage
–OR –
5. Drop Dependents from Medical, Dental or Vision due to New Eligibility for Other Group Coverage |
- Proof of Coverage containing: carrier name, group/employer name, member name and all covered dependent names, plan name and plan effective date
- Proof needed individually for medical, dental and vision if making changes to all three
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Loss of Eligibility of Other Group Coverage
6. Add Self and Dependents to Medical, Dental and or Vision due to Loss of Other Group Coverage |
- Termination notice from carrier or group stating member name, covered dependent names, group/employer name, plan name and plan termination date or COBRA paperwork
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| 7. Phone Number, Address or Email Change |
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| 8. Death of Dependent |
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