If the special open enrollment is due to the enrollment of an extended dependent or a dependent child with a disability, medical coverage will begin the first day of the month following the event date or eligibility certification, whichever is later. Making changes Removing a dependent who is no longer eligible A subscriber must provide notice to remove a dependent who is no longer eligible due to divorce, annulment, dissolution, or a qualifying event of a dependent ceasing to be eligible as a dependent child as described under “Dependent eligibility.” The notice must be received within 60 days of the last day of the month the dependent no longer meets the eligibility criteria. • An employee must provide notice online using Benefits 24/7 (once available) or by submitting a written request to their employing agency. • Any other subscriber must provide notice online using Benefits 24/7 (once available) or by submitting a written request to the PEBB Program. Consequences for not submitting notice within the required 60 days may include, but are not limited to: • The dependent may lose eligibility to continue PEBB medical coverage under one of the continuation coverage options described in “Options for continuing PEBB medical coverage.” • The subscriber may be billed for claims paid by the medical plan for services that were rendered after the dependent lost eligibility. • The subscriber may not be able to recover subscriber-paid insurance premiums for the dependent that lost eligibility. • The subscriber may be responsible for premiums paid by the state for the dependent’s medical plan coverage after the dependent lost eligibility. Voluntary termination for continuation coverage subscribers or retired employees of a former employer group A continuation coverage subscriber or a retired employee of a former employer group may voluntarily terminate enrollment in a medical plan at any time by submitting a request online using Benefits 24/7 (once available) or in writing to the PEBB Program. Enrollment in the medical plan will be terminated the last day of the month in which the request was received online or by the PEBB Program, or on the last day of the month specified in the termination request, whichever is later. If the request is received on the first day of the month, medical plan enrollment will be terminated on the last day of the previous month. Exception: When a subscriber or their dependent is enrolled in a Medicare Advantage or Medicare Advantage Prescription Drug plan, then medical plan enrollment will terminate on the last day of the month when the PEBB Medicare Advantage Plan Disenrollment form (form D) is received. Making changes during annual open enrollment and special open enrollment A subscriber may make certain changes to their enrollment during the annual open enrollment and if a specific life event creates a special open enrollment period. Annual open enrollment changes An employee may make the following changes to their enrollment during the PEBB Program’s annual open enrollment period: • Change their medical plan 158 2024 UMP Classic (PEBB) Certificate of Coverage