Child / Dependent Events
Complete an Enrollment Form and submit it with a copy of the child's certified birth certificate.
Complete an Enrollment Form and submit it with a copy of the court filed adoption paperwork.
- Dependent Child Turns 26
Your dependent child will be considered an eligible dependent through the month of his or her 26th birthday.
Depending on your job and classification (i.e. apprentice, journeyman), while employed for a Contributing Employer you can expect to accrue benefits or begin to accrue benefits in the Health and Welfare, Vacation, Annuity, 401(k) and Pension Funds. Each Fund offers a "safety net" of some kind for when you are no longer employed. For example, the Health and Welfare Fund uses an Hour Bank to help during times of slow or no employment and the Annuity Plan provides benefits upon Retirement.
Active Health and Welfare Plan A and Plan B Trust Fund / Continuation of Eligibility
Hours worked for Contributing Employers are credited to your “Hour Bank”. For each month of eligibility, 100 hours are deducted from your Hour Bank (lag month applies). You may accumulate up to a maximum of 600 hours under Plan A or 300 hours under Plan B. The Hour Bank will provide up to 6 months of future eligibility under Plan A or 3 months of future eligibility under Plan B for periods of slow or no employment*. The 6 months (Plan A) or 3 months (Plan B) will be applied toward any COBRA Continuation period.
*Not applicable to Stakeholders of the Plan.
COBRA: Under the federal law known as “COBRA”, you have the right to continue your health coverage. If employment has been terminated or if you have had a reduction in hours of employment which has caused you to lose eligibility, you have experienced a “Qualifying Event” and are therefore entitled to an additional 18 months of coverage under the Plan from the date of the Qualifying Event, provided election of COBRA and premium payments are submitted in the time limits determined under the law. For more information about COBRA please refer to:
What is COBRA? How do I get it?
Disability: For periods of unemployment due to becoming temporarily Disabled while covered under the Plan, you may qualify for an extension of eligibility. You may be eligible in Plan A for up to 9 months of extended eligibility within a 24-month period or in Plan B for up to 4 months of extended eligibility within a 24-month period. To qualify for the extension you must file an application with the Fund Office no later than 12 months from the First Day of Disability. Other qualification rules apply. Please refer to this page for more information:
Active Health & Welfare Disability
In addition to an extension of eligibility for periods of unemployment due to becoming temporarily Disabled, the Plan offers a Supplemental Weekly Disability benefit if you are disabled more than 28 consecutive days. If you are covered under Plan A, Plan B, or Plan R, you may qualify for a benefit payment of $63 per week for a maximum benefit of 52 weeks. Qualification rules do apply.
Summary Plan Description (Active H&W)
Vacation, Holiday and Sick Leave Trust Fund
Even though the Vacation Fund is designed for an annual January 31st payout, from time to time you may face a period of unemployment for which an alternate payment date may be approved, upon receipt by the Fund Office of an application for Early or Sick Leave Withdrawal. The first two Early Vacation or Sick Leave Withdrawals from the current Benefit Work Year will not be subject to a fee for the portion of your Account scheduled to be paid out on the upcoming January 31st. A third request, or more, from the current Benefit Work Year will be subject to a $150 fee per request.
Annuity Trust Fund
The Annuity Fund is a retirement plan with benefits payable upon Retirement. Like Social Security and the Carpenters Pension Plan, the primary purpose is to provide you with a source of income at retirement. The Annuity Fund is not permitted to provide a benefit prior to Retirement even in cases of hardship.
If you do qualify for Retirement, benefits will be payable. Briefly, to be deemed Retired you must qualify under one of the following rules:
- You are 62 years old and have not received a Contribution for at least 3 months,
- You worked less than 300 hours of Prohibited Employment and stopped working in the Building and Construction Industry in the 24-month period preceding your Retirement,
- You became totally and permanently disabled and receive a Social Security Disability benefit,
- You are in receipt of a Pension benefit from the Carpenters Pension Trust Fund for Northern California,
- You qualify for a hospice program,
- You enter the military,
- You reached your Required Beginning Date (the April 1st following your 70 ½ birthday),
- Your Account is less than $2,000 and you have received less than 300 hours of Contributions to your Account in the 24-month period preceding your Retirement. (This option is available one time only.)
- You are deceased.
For more information regarding Annuity, please refer to the Annuity Withdrawal section of the website.
Summary Plan Description (Annuity)
Payment of your 401(k) account is available at retirement or termination of employment of at least 6 consecutive months. In addition, the Plan may permit you to borrow from your account or take a hardship withdrawal under certain circumstances. (Loans and withdrawals under the Plan may be subject to limitations.) For more information regarding the 401(k) Plan rules, please refer to the 401(k) Withdrawal Rules page.
Summary Plan Description (401k)
The Pension Plan was created to provide you with retirement benefits which, in addition to any benefits from the Annuity Plan, 401(k) Plan and Social Security benefits, will help you enjoy your years of retirement. The Plan does not provide a benefit prior to Retirement.
For periods of unemployment due to becoming temporarily Disabled while covered under the Plan, you may qualify for credit and accrual of retirement benefits for your future retirement. Pension hours may be credited to you if your period of temporary Disability was immediately preceeded by Covered Employment. To qualify for the benefit you must file an application within 12-months of the First Day of Disability, be in receipt of State Disability Insurance, Workers’ Compensation or Longshoremen’s and Harbor Workers’ benefits and have at least 7 full Eligibility Credits without a Permanent Break in Service based on Hours of Work in Northern California. Other qualification rules apply. Please refer to the Temporary Disability page.
Summary Plan Description (Pension)
Northern California Carpenters' Relief Fund
You may qualify for a one-time benefit from the Northern California Carpenters’ Relief Fund. Visit the Northern California Carpenters Regional Council website for more information.
- Leaving Covered Employment or Leaving the Trade
Leaving Covered Employment
If you perform any Non-Covered Employment for an employer who does not contribute to the Plans, your Health and Welfare Hour Bank will be immediately reduced to zero and certain Pension benefits will be delayed or restricted.
Non-Covered Employment means employment in the Building and Construction Industry for an employer that does not have a Collective Bargaining Agreement with the Union or self-employment which is not covered by a Collective Bargaining Agreement.
The following Pension benefits are adversely affected by Non-Covered Employment in the Pension Plan:
- Early Retirement and Service Pensions are delayed 6 months for every calendar quarter in which you worked in Non-Covered Employment. This restriction will not apply to any benefits you accrued prior to July 1, 1991.
- Disability Pensions are not available to you if you have worked in Non-Covered Employment.
- Pre-Retirement Death Benefits are not payable if you die after having worked in Non-Covered Employment.
These Pension restrictions can be repaired if you subsequently return to Covered Employment for a period of time equal to or greater than the period of time spent in Non-Covered Employment and restrictions no longer apply once you reach Normal Retirement Age. Restrictions do apply to all Pension payment forms, including Joint and Survivor Pensions before and after Retirement.
Leaving the Trade
Leaving a trade Covered by the Funds will not result in a reduction of benefits, including cancellation of the Health and Welfare Hour Bank or reduction of Pension benefits.
- Reciprocity: Working as a Union Carpenter Outside of Northern California
If you work outside of the area covered by your Home Fund you may authorize your Home Fund to request the Outside Fund to transmit Employer benefit contributions to your Home Fund. If you make such a request, you are waiving all rights you may have to eligibility for benefits in the Outside Fund but you will be credited contributions to your Home Fund.
For example, if you normally work in Northern California but receive a job offer in Southern California, you may request Northern California ask Southern California to send contributions for work performed in Southern California to Northern California. In this example, Northern California is your Home Fund and Southern California is the Outside Fund.
The benefit eligibility rules of the Home Fund will provide you with Health and Welfare eligibility hours based on the conversion of the Employer contribution from the Outside Fund divided by the Employer contribution required by the Home Fund. Pension contributions are credited based on the hours worked by the Outside Fund.
Requests for transfers of Employer contributions must be received by the Home Fund within 60 days following the beginning of employment under the Outside Fund. The transfer request will remain in effect until you provide a written revocation to end the transfers.
- Military Service
The federal law known as Uniformed Services Employment and Reemployment Rights Act (USERRA) protects the rights of individuals who voluntarily or involuntarily leave employment for military service for all uniformed services. The law not only protects your reemployment but also protects your benefits of employment. Protections apply to all active duty, inactive duty for training, the time required for fitness exams and funeral honors duty. USERRA does place some reporting responsibilities on you. For example, you must inform your employer, hiring hall or Fund Office of your service in advance of leaving employment, but no later than 60 days after your military service begins and you cannot be absent for more than five years. When you return from duty you must also return to work or sign the out-of-work list within a prescribed amount of time.
- If your military service was less than 31 days, you must return by the first full workday after your release from military service, plus a reasonable time for safe transportation and an 8-hour rest period.
- If your military service was 31 to 180 days in length, you must return within 14 days after your release from military service.
- If your military service was 181 days or more, you must return within 90 days after release from military service.
The impact to your benefits is as follows:
Health and Welfare—
If you enter military service fulltime and your service is:
- Less than 31 days, your eligibility will be continued during the period of service with no self-payment.
- 31 days or more, you may continue your eligibility for up to 24 months through COBRA but you will be required to make self-payments for this continued coverage. You may also freeze your Hour Bank which can be used when you return to employment or use your Hour Bank to continue Plan coverage during your service.
If you are a Reservist called to Active Duty (other than a temporary tour of duty of 30 days or less) your coverage will continue for the duration of your tour of duty.
Annuity and 401(k) Plans—
If you enter military service, you can apply for the money in your Annuity Individual Account or 401(k) account if you enlist for regular active duty, or you can leave your Account with the Funds to continue to participate in the earnings and loses of the Funds.
Under the Annuity Plan, USERRA also provides for contributions, but not investment income, to be added to your account upon your return from service, provided you return within the timeline required under USERRA and you worked in a Covered position for a Contributing Employer during the Plan Year* immediately preceding the Plan Year in which you entered into military service, not to exceed 5 years.
*Plan Year is September 1 through August 31.
Upon your return from service, provided you return within the timeline required under USERRA, you may earn Eligibility Credit under the Pension Plan for military service during the period that you retain reemployment rights under USERRA.
For more information regarding the provisions of USERRA in plain language, visit the DOL’s website: www.dol.gov.
- Major Surgery
Maximum Allowable Changes Apply for Certain Surgical Procedures
Charges for surgical procedures can vary greatly among hospitals and facilities; yet, there is little evidence of a higher quality of care at a higher cost facility. Generally, if you have a medically necessary surgery at a PPO facility, services will be subject to your calendar year deductible and paid at normal coinsurance levels. However, there are some specific procedures that have Plan limitations and out-of-pocket protections if you have surgical services at recommended locations. Below is a list of those specific procedures, Plan limitations and recommendations.
- Hospital Plan benefits will be limited to $30,000 for a single hip joint replacement or single knee joint replacement surgery. The maximum applies to all hospital facility costs but does not include professional fees such as anesthesia or surgical fees. There are specific Contract hospitals throughout California where these surgeries can be performed which will minimize your out-of-pocket costs beyond the Plan's deductible and coinsurance. If you require hip or knee replacement surgery, see our list of Value Based Facilities or contact the Trust Fund Office for the list of hospitals that can provide services at a lower cost.
- If you have any of the following surgeries at a hospital instead of an Ambulatory Surgical Center, the Plan limits payment to the hospital to the following amounts:
- Arthroscopic Surgery $6,000;
- Cataract Surgery $2,000;
- Colonoscopy $1,500
- Upper Gastrointestinal Endoscopy $1,500 or $2,000 if a biopsy is taken;
- Other Endoscopy $1,000;
- Esophagoscopy $2,000;
- Hysteroscopy Uterine Tissue Sample $3,500;
- Laparoscopic Gall Bladder Removal $5,000;
- Nasal/Sinus Submucous Resection Inferior Turbinate or Septoplasty $3,000;
- Tonsillectomy and/or Adenoidectomy $3,000;
- Lithotripsy of Kidney Stones $7,000; and
- Inguinal Hernia Repairs $4,000 or Laparoscopic Inguinal Hernia $5,500.
To avoid higher out-of-pocket costs for you, the Plan recommends you use a PPO Contracted Ambulatory Surgical Center for the above procedures because the Plan does not have a maximum payment when an Ambulatory Surgical Center is used, potentially saving you a great amount of money.
To Avoid Other Reductions in Indemnity Plan Benefits
- Use the Plan's Contract Hospitals when you or your eligible Dependents require hospitalization.
- Get a Utilization Review for inpatient Hospital stays. If you use a Contract Hospital, the Hospital will take care of the Utilization Review for you. If you use a Non-Contract Hospital, it is your responsibility to make sure Anthem Blue Cross has pre-approved the hospital confinement or your benefits may not be payable.
- Use Contract Physicians, Hospitals, laboratory and radiology facilities and other Contract Providers such as surgical centers and urgent care facilities. By using Contract Providers, you will receive the maximum benefits payable and save yourself, and the Plan, money.
- If you are an eligible Spouse who works, enroll in your employer’s health plan. A Spouse whose employer offers the opportunity to enroll in health coverage must enroll in that coverage or benefits under this Plan will be reduced. Your Spouse must take offered insurance even if there is a contribution required for that coverage. The requirement applies to Spouses and Domestic Partners only; not to Dependent children.
To ensure you have access and receive your accrued benefits, the Fund Office needs your current address and email address on file. If you move, please complete an Address Change Form as soon as possible and mail, fax or email it to the Fund Office. The Trust Fund address, fax number and email address are:
Carpenters Administrative Office for Northern California
265 Hegenberger Rd., Suite 100
Oakland, CA 94621
Fax: (510) 633-0215
Please note, the Trustees of the Carpenters Annuity Trust Fund and Vacation and Holiday Trust Fund have established policies to locate and pay benefits to missing Participants. The process of locating missing Participants can include one or more of the following efforts, depending on the amount of the unpaid account balance:
- Contact your employer or former employer to obtain your address,
- Contact your Union to obtain your address,
- Send your information to an external commercial locator service that has access to a variety of sources to obtain your address.
In recognition of the cost of such efforts, the Plan(s) will assess your Individual Account(s) a reasonable fee for locating you. To avoid an assessment for location efforts, simply keep the Fund Office apprised of your current address.
- Turning 65
Age 65 is an important milestone under the Health and Welfare and Pension Plans. Under the Retiree Health and Welfare Plan, that is the time you will be transitioned to the Medicare supplemental Plan under the Indemnity Medical Plan or Senior Advantage program under the Kaiser Plan. Regardless, if we’re discussing the Indemnity Plan or Kaiser Plan, both require your enrollment in Medicare.
Enrolling in Medicare at the right time is important. Missing your opportunity to enroll may result in serious financial consequences.
Some people receive Part A and Part B coverage automatically. If you fall in one of the following categories, you will be automatically enrolled and will receive your Medicare card approximately three months before the month you become age 65 and:
- You are in receipt of Social Security benefits;
- You have ALS (Amyotrophic Lateral Sclerosis, also called Lou Gehrig’s disease).
- You are younger than age 65 and have a Social Security Disability Award. If you qualify for Medicare based on your disability, you will receive your Medicare card approximately three months before your 25th month of disability.
Some people have to sign up for Part A and Part B benefits. If you are not receiving your Social Security benefits or if you qualify for Medicare because you have End-Stage Renal Disease (ESRD), you need to apply for Medicare. There are three ways to complete an application:
- Apply online at www.ssa.gov/medicare/apply.html.
- Call Social Security at (800) 772-1213.
- Visit your local Social Security office.
You should apply for Medicare three months before turning age 65, even if you are not planning to receive Social Security benefits. You can request Social Security retirement benefits separate from Medicare enrollment at a later date. If you don’t enroll in Medicare on time, there may be a significant delay in your effective date of benefits.
For more information about Medicare enrollment, you can call (800) 633-4227 or research online at www.medicare.gov.
If you elected Kaiser for your medical plan, there is an additional form that must be completed called the Senior Advantage Enrollment Form. If you did not receive the Form from the Fund Office or Kaiser and are approaching age 65, please contact the Fund Office as soon as possible to prevent a disruption in your benefits.
Pension Plan implications of turning age 65. If you stop working but you do not apply for your benefits until after age 65 (also called Normal Retirement Age), the monthly benefit you receive when you do begin your pension will be actuarially increased to make up for missed payments since you turned age 65. The increase will be .75% for each complete calendar months between age 65 and age 70, and 1.5% for each complete calendar month between age 70 and your Pension Effective Date (see Section 10.09. of the Pension Plan Rules and Regulations), excluding any months in which your benefits would have been suspended.
Instead of an actuarial increase, you may elect to receive the missed monthly payments since your Normal Retirement Age in a lump sum. This one-time cash payment would be equal to your monthly benefit multiplied by the number of complete calendar months between your Normal Retirement Age and your Pension Effective Date, but excluding those months during which your benefits would have been suspended. Monthly payments of your benefit would then begin on your Pension Effective Date.
For benefits accrued after Normal Retirement Age, the actuarial adjustment will start from the date benefits would first have been paid rather than Normal Retirement Age.
If you reach your Normal Retirement Age and do not apply for benefits, the Fund Office will attempt to contact you advising you of the Plan’s available benefits.
Guide to Filing for Social Security, Understanding the Medicare System, and Employment after Retirement
- Temporary Disability
If an Active Participant becomes disabled and is collecting temporary State Disability Benefits or temporary Workers' Compensation Benefits, you may be eligible for supplemental disability benefits through the Health and Welfare Fund. There are three benefits offered for participants who qualify, including:
- $9 a day payable the starting with the 29th day of Disability
- An Extension of Health and Welfare Benefits to keep your eligibility going while temporarily disabled
- Pension Credit while out on temporary disability
- Permanent Disability
If you have been classified as Permanently Disabled from Social Security Administration, submit a copy of that award letter as soon as possible. Being classified as permanently disabled could get you access to your retirement account earlier than regular retirement age.
Contact Benefit Services about six months prior to the desired Retirement date. At this time you can go over estimated payments and learn about the required documentation needed to complete the retirement process.
- Returning to Work
Contact Benefit Services when you consider returning to work after retirement. There are different rules based on your age, potential employment type, and job location. Participants are advised to submit their request in writing to the Prohibited Employment Committee that states when they will be returning to work, what you will be doing for work, job location, and how many hours a week/month they plan on working. Benefit Services will reply in writing. A violation of Prohibited Employment rules could jeopardize your Pension payments and/or Retiree Health and Welfare eligibility.
- Retirement Planning
A good starting point for Retirement planning is your Quarterly Statement. At the bottom of the Pension page it will give you an estimated Pension and Annuity amount. You can always contact Benefit Services for more details.
- Death of a Participant, Spouse, or Beneficiary
Life insurance for the Participant
If you are eligible under the Active Health and Welfare Plan (except Plan R), $15,000 in group life insurance benefits will be paid to your beneficiary in the event of your death from any cause while eligible under the Plan. To receive the benefit payment, the beneficiary must be living on the earlier of the following dates:
- The date the insurance company receives proof of your death.
- The tenth day after your death.
Your beneficiary may be any person or persons you name on your Enrollment Form. If there is no eligible beneficiary, or if you did not name one, benefits will be paid to the surviving person or persons in the following order:
- Your Spouse or domestic partner
- Natural and adopted children
- Brothers and sisters
You may request a change of Beneficiary at any time by submitting a new Enrollment Form or Beneficiary Designation Form to the Trust Fund Office. If you have named an irrevocable beneficiary, the insurance company must first have the written consent of that beneficiary. A change in beneficiary will take effect as of the date it is signed by you but will not affect any payment the insurance company makes or action it takes before receiving your notice.
The individual named as your beneficiary on your Enrollment Form or Beneficiary Designation Form will be the person to whom Vacation benefits will be paid in the event of your death. If you did not name a beneficiary or if the named beneficiary is deceased or cannot be located, benefits will be paid to the person(s) entitled to the benefits under the law.
An application for benefits due to death must be filed by the beneficiary, along with a certified copy of the death certificate. The claim to the benefit should be made with the Fund Office at the earliest possible time.
You may request a change of Beneficiary at any time by submitting a new Enrollment Form or Beneficiary Designation Form to the Trust Fund Office.
Annuity and 401(k) Benefits
Your designated Beneficiary or your Surviving Spouse may be eligible to receive the money in your Individual Account if you become deceased.
If you were married throughout the one-year period ending on your death, your Surviving Spouse can receive the money in your Individual Account under any of the payment forms that would otherwise be available to you, however if the value of your Account does not exceed $5,000, your account will be paid in a single, lump sum payment.
If you are not married, or were not married throughout the one-year period ending on your death, of if your Spouse has properly consented to your choice of another Beneficiary, the Beneficiary will receive the money in your Individual Account as a lump sum. The Beneficiary may choose to roll the payment over to either an Individual Retirement Account (IRA) or an Individual Retirement Annuity specifically established for the purpose of receiving this type of payment (“inherited IRA”), or lump sum partial payment.
If you are married and wish to name someone other than your legal Spouse as your Beneficiary, you may do so, but must obtain your Spouse’s written consent, witnessed by a notary public or Plan Representative. You may change your Beneficiary any number of times prior to your death, however, your Spouse’s written consent is required each time you designate a new Beneficiary (unless your Spouse waived that right). A Spouse may also revoke his or her consent at any time prior to your death with the result being that he or she would then be entitled to the money in your Individual Account.
In order for your Beneficiary designation to be effective, it must be received by the Plan prior to your death. If there is no valid Beneficiary designation on file or the designated Beneficiary is not alive at the time benefits are payable, then benefits will be paid to the following parties in the following order of priority:
- Your surviving Spouse; or if none,
- Your natural or adopted children in equal shares; or if none,
- Your surviving parent(s) in equal shares; or if none,
- Your surviving brothers and sisters in equal shares (not applicable to the 401(k) Plan); or if none,
- Your executor or administrator of your estate. If you do not have an estate, then no payment of any kind will be made.
If you designate your Spouse as Beneficiary and you and your Spouse later divorce, the designation of your now former Spouse is automatically revoked, unless you are required by court order to maintain your former Spouse as Beneficiary. If you wish to keep your former Spouse as your Beneficiary, you must complete a new Beneficiary Designation Form naming your former Spouse as Beneficiary.
If you are Retired, were married throughout the one-year period ending on your death and elected a Joint and Survivor Pension payment form, upon your death, your Pension will be converted to a Survivor Pension of 50%, 75% or 100% of the payment while you and your Spouse were both alive. The percentage of the Survivor Pension was determined at the point of Retirement.
If you are Retired and were not married at Retirement, or were not married throughout the one-year period ending on your death the Pension Plan offers a “Guarantee Period” on Single Life Pensions. A Single Life Disability Guarantees a minimum of 36 payments and all other Pensions guarantee a minimum of 60 payments. If you become deceased before the minimum number of months are paid, your Beneficiary will receive monthly benefits until the Guarantee Period is complete.
For purposes of the Guarantee Period, a Beneficiary is your Surviving Spouse if you are married or if not married, the Beneficiary is anyone of your choosing.
If you are not yet Retired and become deceased, the Pension Plan offers a Pre-Retirement Death Benefit to both married and unmarried Vested Participants. The Pre-Retirement Death Benefit provides for 36 monthly payments of your accrued Pension benefit beginning with the month following death.
To qualify for the Pre-Retirement Death Benefit you must have 10 Northern California Pension Eligibility Credits, and have not worked Non-Covered Work (non-Union). Non-Covered Work can be “repaired” by an equal or greater amount of time in Covered Employment after the Non-Covered work was performed.
If you are not yet Retired, have been married for at least a one-year period ending on your death, a 50% survivor Pension is payable to your Spouse for your Spouse’s lifetime on the date of what would have been your earliest Retirement age. If your Spouse is also eligible for the Pre-Retirement Death Benefit, your Spouse will have to choose between the 50% survivor Pension or the Pre-Retirement Death Benefit. Only one will be payable.
- Domestic Partnership
A Domestic Partner is a person who resides with the Participant in the same residence and is at least 18 years of age and whose relationship with the participant meets the following requirements:
- The Domestic Partner and the Participant have been in an intimate, committed relationship of mutual caring for a period of at least six months and are each other’s sole domestic partners.
- The Domestic Partner and the Participant share joint responsibility for each other’s common welfare and financial obligations and can submit proof of that relationship as required by the Board of Trustees.
- Neither the Domestic Partner or Participant is married.
- The Domestic Partner and the Participant are each competent to contract.
- The Domestic Partner and Participant are not related by blood closer than would prohibit legal marriage in the State of California.
- Any prior domestic partnership of either person has been terminated at least 6 months prior to the date of the signing of the final declaration of domestic partnership with the Trust Office.
- Application for domestic partnership with the Participant is properly made as required by the Board of Trustees. This will include:
1. An Enrollment Form
2. Proof of joint financial responsibility
3. Two months of prepaid taxes
To add your Spouse as a dependent under the Plan you must complete an Enrollment Form and submit a copy of your certified marriage certificate.
To remove a former Spouse from the Plan you must submit a copy of your final divorce decree that has been signed and stamped by the court along with a copy of the marital settlement agreement. You should also complete a new Enrollment Form or Beneficiary Designation Form to update your Beneficiary information. Your former Spouse will no longer be an eligible dependent under the Plan effective the date of divorce.