Division of Temporary Disability and Family Leave Insurance

Life Changing Event Information

Staff is resposible to complete and submit the following documents when changing their legal name or address

• Active employees in SHBP/SEHBP must file a Change of Address form
• Pro Act Name Change Form
• Dental Coverage

Birth/Adoption/Award of Legal Guardianship

• It is your responsibility to add a dependent to your health plan coverage within 60 days of the qualifying event. You also must submit proof of dependency documentation along with your application to the Bayonne Board of Education Pension & Benefits Office.
  • If you miss the deadline, you will have to wait until the annual open enrollment period (annually in October) to add your dependent to your plan. Coverage will be effective January 1. There may be a change in the amount deducted from your pay due to your coverage-level change.
• Employees can easily review and change life insurance/pension beneficiary designations online using MBOS. 

Insurance Applications to Add Newborn

Change in Dependent Status

When adding or removing a dependent child from your coverage (for any reason) there may be a change in the amount deducted from your paycheck or retirement check (if self-paid) due to your coverage-level change.

• To remove a child from your health coverage, Active Employees should submit an application to the Bayonne Board of Education Pension & Benefits office. Retirees and COBRA recipients must submit an application directly to the NJDPB.
• Dependent children's coverage will be terminated at the end of the year in which they turn age 26. It is your responsibility to apply for continued coverage under Chapter 375 or COBRA for the dependent child, if desired.
• A child who has reached age 26 and is disabled due to a mental or physical disability and dependent upon you for support can remain covered as a dependent if the child's disabled status is approved.
• A child who has reached age 26 and a COBRA recipient may continue coverage under COBRA for a period of 36 months.

If your spouse’s employment status changes (e.g., starts or leaves a job), you can enroll/disenroll him or her in your health plan. Proof of new coverage or proof of loss of coverage is required. There will be a change in the amount deducted from your paycheck or retirement check (if self-paid) due to your coverage-level change. Active Employees should submit an application and proof of coverage documentation to their Human Resources department. Retirees and COBRA recipients should submit an application and proof of coverage documentation to the NJDPB.

Divorce/Dissolution

If you divorce or dissolve your civil union or domestic partnership, you must remove your former spouse or partner from your health plan when the event occurs. There will be a change in the amount deducted from your paycheck or retirement check (if self-paid) due to your coverage-level change.

• Active Employees must notify Bayonne Board of Education Pension & Benefits office.
• Retirees and COBRA recipients must submit an application to change status to the NJDPB.

Other Considerations:

• Review your life insurance and pension beneficiary designations via MBOS. Look for "Access myNewJersey” above.
• Review the NJDPB Divorce and Qualified Domestic Relations Order (QDRO) Fact Sheets.

Marriage/CivilUnion/Domestic Partnership

• It is your responsibility to add a new spouse/partner to your health plan coverage within 30 days of the date of marriage or partnership. You also must submit proof of dependency documentation along with your application to Bayonne Board of Education Pension & Benefits office.
  • If you miss the deadline, you will have to wait until the annual open enrollment period (annually in October) to add your dependent to your plan. Coverage will be effective January 1. There may be a change in the amount deducted from your pay due to your coverage-level change.
• Employees can easily review and change life insurance/pension beneficiary designations online using MBOS. Look for "Access myNewJersey" above.

Report of Death

The NJDPB should be notified of the death of an employee or retiree as soon as possible. Beneficiaries of pension and/or life insurance payments and surviving spouse/partner/dependents on the member's health insurance coverage will be notified by mail. Required forms and documentation should be returned to the NJDBP immediately in order to process payments and/or provide insurance.

Death of Spouse/Partner/Dependent: If your spouse/partner or dependent child passes away, he or she must be removed from your health plan. There may be a change in the amount deducted from your paycheck or retirement check (if self-paid) due to the coverage-level change.

• Active Employees must notify the Bayonne Board of Education Pension & Benefits office.
• Retirees and COBRA recipients must submit an application to change coverage level to the NJDPB.

Other Considerations:

• Review your life insurance and pension beneficiary designations via MBOS and make changes as necessary.