Reso 2010-1529 - Laserfiche WebLink

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4.03.01 4.03.02 A V-ClIOICE-2009 MP-5320 (10/09) "} An eligible employee or Dependent may request to enroll in the Plan outside of the initial enrollment period and annual open enrollment periods if that individual loses other coverage or acquires a new Dependent as outlined below: a) If the eligible employee or Dependent declined coverage under the Plan when it was first offered because of other group health plan coverage or insurance coverage and such coverage has terminated as a result of: I) Exhaustion of COBRA continuation coverage; 2) Teonination of employment or reduction in hours of employment; 3) Termination of employer contributions; 4) Legal separation, divorce or annulment; 5) Change in Dependent status; 6) Death of an employee; 7) Change in legal custody or legal guardianship; 8) Relocation out of an HMO Service Area; 9) Attainment of lifetime maximum. 10) The eligible employee, Subscriber or Dependent must complete and submit an Enrollment or Status Change form within 31 days of the teonination of other coverage and provide proof of continuous coverage under the other plan. If an employee is eligible but not enrolled, the employee will also be required to enroll at this time. ) - } b) If the eligible employee or Subscriber acquires a new Dependent as a result of: I) Marriage; 2) Birth; 3) Adoption or placement for adoption; 4) The eligible employee, Subscriber or Dependent must complete and submit an Enrollment or Status Change form within 31 days of the date the Dependent becomes eligible (or within 60 days as required for newborns). If an employee is eligible but not enrolled, the employee will also be required to enroll at this time. Employees and their Dependents who are eligible for coverage but not cnroIled, shall be eligible to enroll for coverage within 60 days following: a) Teonination of coverage under Medicaid or Children's Health Insurance Plan (CHIP) due to loss of eligibi)ity; or b) Determination of eligibility for premium assistance under Medicaid or CHIP. c) The employee or Dependent must complete and submit an EnroIlment or Status Change form within 60 days of the date of the loss of Medicaid or CHIP coverage, and within 60 days of the deteonination of eligibility for premium assistance under Medicaid or CHIP. If an employee is eligible but not enrolled, the employee will also be required to enroll at this time in order to cover an eligible Dependent. ) 11