Effective January 1, 2002, the State has emplemented an additional process to apply for health insurance coverage for those employees and their dependents who did not enroll when first eligible and who don't meet a Qualifying Event.

The process consists of a medical questionnaire that the employee will complete.  You may get the form from Christy at Central Office.
 

The procedure for this new process is as follows:

1. Employee should request the Application for Late Enrollment from Christy at Central Office.

 
2. The employee must complete the application, and send it to Fort Dearborn Insurance Company.  A money order or cashier's check in the amount of $60.00 must be included with the application.  The application fee is non-refundable even if the applicant is denied coverage.

 
3. Fort Dearborn will process the application for an approval, denial, or will request additional information, if needed.  If additional information is needed, the employee will have 60 days from the original request date to return the necessary information.

 
4. The decision will be sent directly to the employee.  If approved, the employee must bring a copy of the approval letter to Christy Wolfe at Central Office and must complete an enrollment form.  The approval letter must be submitted to Christy within 60 days of the date of the letter from Fort Dearborn.