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Mailing Address: U.Va. Human Resources 914 Emmet Street P.O. Box 400127 Charlottesville, VA 22904 Phone: (434) 924-4598 Email: hrdept@virginia.edu

If You Become Divorced Life Events Birth or Adoption Marriage Divorce Death of an Employee Continuation of Benefits (COBRA) Medical Care Out of the Network Eligibility for coverage for your spouse under the Plan terminates at the end of the month that you divorce. However, your spouse may elect to continue health care coverage under the Plan by purchasing coverage under COBRA for up to 36 months. Based on the Health Plan in which you are enrolled, there are specific rules about how much time you have to drop your former spouse. If you are covered as an active employee under Southern Health on the UVa Health Plan, you or your spouse must notify the University Human Resources Office of Employee Benefits within 60 days of the date of the final divorce decree to drop your former spouse in order for your spouse to be eligible to obtain COBRA continuation coverage and so that you will not continue to a pay premium for this coverage. If you are covered under the MAMSI plan, you have 31 days to drop your former spouse. If you are a Retiree on the UVA Health Plan or UVA Health Plan COBRA member, you have 31 days to drop your former spouse. When Coverage Ends and Premiums Change The change you make will be effective the first of the month following the date of divorce as long as the timeframes described above are met. Failure to notify the Office of Employee Benefits within the timeframes will result in coverage being terminated for the ineligible former spouse the first of the month following the divorce but premiums will not change until the first month following receipt of the application What You Need to Do You will need to complete a health plan application to terminate your ex-spouse from the Health Plan and submit it to the University Human Resources Office of Employee Benefits within 60 days of the date of the divorce (or 31 days if you are a housestaff or post doc on MAMSI, or UVA Health Plan Retiree or COBRA member ) so that you will not continue to pay a premium for this coverage. You will also need to provide a copy of the signed pages of the divorce decree verifying the parties involved and the date of divorce, along with your application to terminate coverage. A qualified medical child support order (QMCSO) or a qualified domestic relations order (QDRO) could have an effect on your benefit coverage or elections. Please notify the University Human Resources Office of Employee Benefits if you become aware of an order like this as part of divorce proceedings. Your former spouse should review the COBRA information he or she receives and enroll in coverage within the specified guidelines described in the COBRA notification letter, if he or she would like to continue coverage under the Plan. Other Benefits to Consider As a result of your divorce you may also be able to make changes to some of your other benefits. Contact the Office of Employee Benefits for information about the following: Dependent Group Life Insurance Coverage Beneficiary Designations Medical and Dependent Flexible Spending Accounts

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