| M-2a |
Description |
| Add Coverage |
Adding Child(ren) - After the Event (Adoption, Birth, Legal Custody, Guardianship of Minor) |
| Adding Child(ren) - Before the Event (Adoption, Birth, Legal Custody, Guardianship of Minor) |
| Loss of Coverage - Enrolling as "Late Entrant" |
| Marriage - Add Dependent(s) - After the Event |
| Marriage - Add Dependent(s) - Before the Event |
| Cancel Coverage |
Cancel Dependent(s) |
| Cancel Spouse due to Divorce |
| Death & Survivor |
Death of Dependent(s) |
| Survivor - Retain Medical Coverage |
| Leave of Absence |
Continue Coverage |
| Cancel Coverage |
| Long-Term Disability |
Add Coverage |
| Cancel Coverage |
| Go to State Spouse's Coverage - Subscriber Form (Include Spouse's M-2a Form. See next Example.) |
| Go to State Spouse's Coverage - Spouse Form (Include Spouse's M-2a Form. See previous Example.) |
| Personal Information Changes |
Address Change |
| Name Change |
| Retirement |
Add Coverage |
| Continue Coverage |
| Go to State Spouse's Coverage - Subscriber Form (Include Spouse's M-2a Form. See next Example.) |
| Go to State Spouse's Coverage - Spouse Form (Include Spouse's M-5a Form. See previous Example.) |
| Terminate or Decline Coverage |
| Terminate State Employment - Non-Vested |
Cancel Coverage |
| Go to State Spouse's Coverage - Subscriber Form (Include Spouse's M-2a Form. See next Example.) |
| Go to State Spouse's Coverage - Spouse Form (Include Spouse's M-2a Form. See previous Example.) |
| Terminate State Employment - Vested |
Add Coverage |
| Cancel Coverage |
| Continue Coverage |
| Go to State Spouse's Coverage - Subscriber Form (Include Spouse's M-2a Form. See next Example.) |
| Go to State Spouse's Coverage - Spouse Form (Include Spouse's M-8a Form. See previous Example.) |
| Transfer |
Transfer of Employee to State Agency |
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