|"A Community of 21st Century Learners"|
|53 West Mill Road, Long Valley, NJ 07853||P: 908.876.4172 F: 908.876.9392|
DIVORCE or LEGAL SEPARATION
REMOVING A SPOUSE FROM YOUR HEALTH BENEFIT PLANS
These forms must be received at the Board of Education office no later than 60 days after a divorce or 31 days after a legal separation, in order to terminate coverage for a spouse. Please also note that in cases of legal separation, once you terminate coverage for your spouse you will not be able to re-enroll them, should anything change, until the next annual open enrollment period.
The Washington Township Board of Education is required by law to send the (ex) spouse and any covered dependents a Cobra continuation of coverage notice upon termination, so please be sure to include their current address on the form.
This form is for all employees.
If this change in status changes the plan type you have (Family to Parent/Child, etc.), your health benefit contribution will be adjusted accordingly. Employees can calculate their benefit contribution amount by using the 'Benefit Contribution Charts' on the district website.