October 17, 2016 – October 28, 2016
Effective Dates of Coverage
December 1, 2016 – September 30, 2017
If You Want To:
Enroll in MetroPlus GoldCare I or MetroPlus GoldCare II coverage and the Welfare Fund: Fill out the Welfare Fund Enrollment Form (sent to you by mail). Check the name of the plan you wish to enroll in. Include the names of the eligible dependents that you wish to be covered for health insurance. Do not include dependents that are not to be enrolled.
Opt-out of coverage: Fill out the Enrollment Waiver to Opt-Out of enrollment in the Fund and its benefits including health insurance coverage. The Enrollment Waiver must be notarized and proof of other insurance coverage must be submitted to your center bookkeeper along with the waiver.
Regardless of your current coverage, you MUST take action for the plan year December 1, 2016 – September 30, 2017