Mid-Year Health Care Enrollment Changes
You may NOT make changes between Open Enrollment periods unless you have an eligible change-in-status event, as described below, or you want to disenroll from a Medicare HMO.
Change-in-Status Events
If you are enrolled and have a change-in-status event as described in this subsection, you may make changes in your benefits coverage that are generally consistent with your change-in-status event. For example, if you get divorced, you must disenroll your ex-spouse; however, you may not add other dependents or change plans.
Some change-in-status events are listed in the following chart. Also see: Birth or Adoption Change-In-Status Provisions, Move Out of HMO Service Area, and Disenrollment From a Medicare HMO.
Change-in-Status Events
  • Marriage or the establishment of a registered domestic partnership (for Retirees only).
  • Divorce (must be final), annulment, final legal separation, or the termination of a registered domestic partnership. Please note that you cannot cover your ex-spouse, common-law spouse, or legally-separated spouse or former domestic partner on your Company-sponsored health care plans even if a court orders you to provide coverage.
  • Birth or adoption of a child, or your court-ordered appointment of legal guardianship for a child.
  • Your dependent child loses or regains eligibility.
  • Your child or your registered domestic partner's child reaches the Plan's age limit, gets married, or enters the military.
  • You or your dependent becoming Medicare- or Medicaid-eligible.
  • The death of your spouse/registered domestic partner or dependent child.
  • A move out of your medical plan's service area (applies to change of medical plan only).
  • The following additional change-in-status events apply to Retirees only when the retiree is already enrolled and the retiree's spouse or domestic partner has a change to or from full-time or part-time employment or takes an unpaid leave of absence:
    • A change to or from full-time or part-time employment by your spouse/registered domestic partner or dependent, if health plan eligibility is affected.
    • An unpaid leave of absence taken by your spouse/registered domestic partner that significantly impacts the cost of your health care coverage.
Call the PG&E Benefits Service Center within 31 days of any change-in-status event (180 days for births or adoptions, with the exception of Kaiser Senior Advantage HMO plan, in which you only have 60 days to notify them) which may affect your benefits. Written documentation may be requested. If notification is not made in a timely manner, you will not be able to add dependents. Provided you notify the PG&E Benefits Service Center within 31 days of any change-in-status event (180 days for births or adoptions, with the exception of Kaiser Senior Advantage HMO plan in which you only have 60 days to notify them), the change in coverage for all newly-enrolled dependents will take effect:
  • on the date of birth of your newborn or newly-adopted child(ren),
  • on the date you assume physical custody or financial responsibility for an adopted child, or
  • on the first day of the month following notification of your change-in-status event for all other status changes.
Birth or Adoption Change-in-Status Provision
Under the Anthem Blue Cross-administered plans, you must notify the PG&E Benefits Service Center of your child's birth or adoption within 180 days, or your newborn or newly-adopted child's coverage will terminate on the 180th day. No late enrollments will be accepted.
Under the HMO plans, you must notify the PG&E Benefits Service Center within 180 days of your child's birth or adoption, with the exception of Kaiser Senior Advantage HMO plan, in which you only have 60 days to notify them. If you do not, your newborn or newly-adopted child's medical expenses will not be covered from the date of birth or adoption. Please check with your HMO for more details on coverage for newborn and newly-adopted children. No late enrollments will be accepted.
To avoid the possibility of uncovered expenses, you must enroll your newborn or adopted child promptly by notifying the PG&E Benefits Service Center within 180 days for births or adoptions, with the exception of Kaiser Senior Advantage HMO plan, in which you only have 60 days to notify them.
Move Out of the Service Area
If you move out of your plan's service area, you must re-enroll in a different medical plan. You may select from any available carriers in the new area based on your ZIP Code. Be sure to notify the PG&E Benefits Service Center of your change of address within 31 days of your move. If you notify the PG&E Benefits Service Center of your move within 31 days, enrollment in your new medical plan will take effect on the first day of the month following your notification. If you do not notify the PG&E Benefits Service Center within 31 days, you may not be eligible for services under your health plan, or you may receive lower benefits.
If you are currently enrolled in an Anthem Blue Cross-administered plan that bases eligibility on your home ZIP Code and you subsequently move your residence out of that ZIP Code, you will automatically be enrolled in the appropriate Anthem Blue Cross-administered plan for your new home ZIP Code. For instance, if you live in the San Francisco Bay Area and are enrolled in NAP and you subsequently move to a state where NAP is not offered, you will be enrolled in CAP.