Life Events

Congratulations! 

Submit the following to the Benefits Department within 30 calendar days of the event:

• Enrollment form signed and completely filled in with existing or new benefits. You must include the child’s Social Security number on the enrollment form.
• Copy of birth certificate naming you as the parent. If the birth certificate is not available within 30 days of the birth, a copy of the live birth certificate or birth record from the hospital is acceptable. Send a copy of the birth certificate to the Benefits Department once received.
• If adoption, a copy of the court order/adoption decree naming you as the child’s parent or current legal guardian AND a copy of the child’s birth certificate.
• Documents can be scanned and emailed to [email protected] or mailed to the Benefits office at 451 W. Third Street, 9th Floor, Dayton, OH 45422-1340.

If the enrollment form with required documentation is not received within 30 calendar days of the event date, your dependent will not be eligible for coverage until the next annual enrollment period or within 30 days of another life event.

Submit the following to the Benefits Department within 30 calendar days of the event:

• Enrollment form signed and completely filled in with existing or new benefits. 
• Spouse’s name, date of birth, and social security number must be listed on the enrollment form.
• Copy of official marriage certificate (not marriage license).
• If additional dependents are being added, attach a copy of the birth certificate. The date of birth and the social security number must be included on the enrollment form for each dependent.
• The documents can be scanned and emailed to [email protected] or mailed to the Benefits office at 451 W. Third Street, 9th Floor, Dayton, OH 45422-1340

If the enrollment form with required documentation is not received within 30 calendar days of the event date, your spouse will not be eligible for coverage until the next annual enrollment period or within 30 days of another life event.

Submit the following to the Benefits Department within 30 days of the event:

• Enrollment form signed and completely filled in with existing or new benefits.
• Copy of time stamped divorce decree.
• If additional dependents are being added, attach a copy of the birth certificate. The date of birth and the social security number must be included on the enrollment form for each dependent.
• The documents can be scanned and emailed to [email protected] or mailed to the Benefits office at 451 W. Third Street, 9th Floor, Dayton, OH 45422-1340

If the enrollment form and required documentation is not received within 30 calendar days of the event date, you will only be permitted to remove your ex-spouse. No other plan changes will be permitted, including changes to your enrollment tier, until the next annual enrollment period or within 30 days of another life event.

Submit the following to the Benefits Department within 30 calendar days of the event:

• Enrollment form signed and completely filled in with existing or new benefits. 
• Documentation showing date of coverage change. Documentation can include a copy of the insurance card showing effective date of new coverage, a printout or letter from the insurance company showing the coverage termination date, or a statement from a spouse’s or dependent’s employer showing the date of coverage change.
• The documents can be scanned and emailed to [email protected] or mailed to the Benefits office at 451 W. Third Street, 9th Floor, Dayton, OH 45422-1340.

If the enrollment form with required documentation is not received within 30 calendar days of the event date, you will not be permitted to make a change to your benefits until the next annual enrollment period or within 30 days of another life event.

Submit the following to the Benefits Department within 30 calendar days of the event:

• Enrollment form signed and completely filled in with existing or new benefits.
• Enrollment forms can be found at www.mcbenefits.org under the Forms tab.
• Copy of the death certificate.
• The documents can be scanned and emailed to [email protected] or mailed to the Benefits office at 451 W. Third Street, 9th Floor, Dayton, OH 45422-1340

If the enrollment form and required documentation is not received within 30 calendar days of the event date, you will only be permitted to remove the dependent from coverage. No plan changes will be permitted, including changes to your enrollment tier, until the next annual enrollment period or within 30 days of another life event.