Special enrollment for certain qualifying events

An eligible employee, retiree, or surviving spouse who has accepted a periodic distribution from the defined contribution retirement plan or a monthly retirement benefit from the North Dakota public employees retirement system, North Dakota highway patrol's retirement system, the retirement system established by job service North Dakota, the judges' retirement system, the teachers' fund for retirement, or teachers' insurance and annuity association of America - college retirement equities fund, or retirees who have accepted a retirement allowance from a participating political subdivision's retirement plan and provide verification of distribution are eligible for coverage with the health, dental, vision, or prescription drug insurance program. 1. The eligible employee, retiree, or surviving spouse shall submit application for coverage within thirty-one days from one of the following qualifying events: a. If the eligible retiree turns age sixty-five or becomes eligible for Medicare. b. If the eligible retiree's spouse turns age sixty-five or becomes eligible for Medicare. c. If the eligible employee terminates employment. d. If the eligible retiree or surviving spouse receives the first monthly retirement benefit from one of the eligible retirement systems outlined above. e. If an eligible employee or retiree who is covered through another employer-sponsored plan becomes ineligible for the other employer-sponsored plan due to divorce, death, loss of employment, reduction in hours or other events which may cause loss of coverage as determined by the board. f. If the eligible employee or retiree is no longer eligible for employer-sponsored group insurance, including continuation coverage provided under the Consolidated Omnibus Budget Reconciliation Act of 1985. g. If the eligible employee, retiree, or surviving spouse gets married (in which case, an employee, retiree, or surviving spouse who previously waived coverage shall enroll for coverage at the time the employee's, retiree's, or surviving spouse's spouse is enrolled). h. If the eligible employee, retiree, or surviving spouse obtains a new dependent as a result of receiving legal guardianship or receiving a court order to provide health coverage (in which case, an employee, retiree, or surviving spouse who previously waived coverage shall enroll for coverage at the same time that the employee, retiree, or surviving spouse's eligible dependent is enrolled). i. If the eligible employee, retiree, or surviving spouse obtains a new dependent as a result of birth, adoption, or placement for adoption (in which case, an employee, retiree, or surviving spouse who previously waived coverage shall enroll for coverage at the same time that the employee, retiree, or surviving spouse's eligible dependent is enrolled). 2. Coverage becomes effective on the first day of the month following the month in which the qualifying event occurred except under subdivision a or b of subsection 1 coverage may become effective the month in which eligibility for Medicare occurs and under subdivision i of subsection 1 coverage becomes effective on the first of the month in which the event occurred. If an application is not submitted within thirty-one days of a qualifying event, the eligible employee, retiree, or surviving spouse must be considered to have waived coverage and may not be enrolled unless the eligible employee, retiree, or surviving spouse meets the criteria of another qualifying event. Upon a showing of good cause, the executive director may waive the thirty-one day application requirement. 3. Other individuals eligible for the health, dental, vision, or prescription drug insurance plan include a surviving spouse who is not receiving a qualified monthly retirement benefit from one of the eligible retirement systems outlined above, but who was a covered dependent on the eligible retiree's health, dental, vision, or prescription drug insurance plan at the time of the eligible retiree's death, if there is no lapse in coverage. 4. Individuals not eligible for the health, dental, vision, or prescription drug insurance plan include: a. A former employee who received a refund of the employee's retirement account, including individuals in the defined contribution plan who take a cash withdrawal of the employee's account, roll their account into another qualified plan, or use the moneys in their account to purchase an annuity. b. A nonspouse beneficiary (eligible for continuation coverage under the Consolidated Omnibus Budget Reconciliation Act of 1985). c. A deferred retiree or surviving spouse between the time in which the retiree or surviving spouse's eligibility for continuation coverage under the Consolidated Omnibus Budget Reconciliation Act of 1985, if eligible, ends and the month in which the eligible retiree or surviving spouse receives the first monthly retirement benefit from one of the eligible retirement systems. d. A formerly deferred retiree who received a refund of the retiree's retirement account. e. A surviving spouse of a nonvested employee eligible continuation coverage under for the Consolidated Omnibus Budget Reconciliation Act of 1985. f. A surviving spouse of a former employee who received a refund of the employee's retirement account. g. A former participating member of the defined contribution retirement program who would not qualify for one of the retirement dates set forth in subsection 3 of North Dakota Century Code section 54-52-17 if that employee was a member of the defined benefit retirement plan, unless eligible for continuation coverage under the Consolidated Omnibus Budget Reconciliation Act of 1985, and then only for the required duration of eligibility under the Act. h. For the purposes of the medical and prescription drug plan, employees who first retire after July 1, 2015, and are not eligible for Medicare upon their retirement and completion of any period of eligibility for continuation coverage under the Consolidated Omnibus Budget Reconciliation Act of 1985, until such time as they or their spouse become eligible for Medicare.