Part 11 – Group Policy (continued) WORDS IN ITALICS ARE EXPLAINED IN PART 2. Page 97 Loss of Other Qualified Coverage An eligible employee may choose not to enroll themself or an eligible dependent (including a spouse) for coverage in this health plan under a group contract on the initial group eligibility date because they or the eligible dependent has other health plan coverage as defined by federal law. (This is referred to as “qualified” coverage.) In this case, the employee and the eligible dependent may enroll under the group contract if the employee or the eligible dependent at a later date loses that other qualified health plan coverage due to any one of the following reasons.  The employee or the eligible dependents (including a spouse) cease to be eligible for the other qualified health plan. For example, this could mean that the loss of the other qualified health plan was due to: the loss of the spouse’s coverage; the death of the spouse; divorce; loss of dependent status; or involuntary termination. This includes when an employee or eligible dependent is covered under a Medicaid plan or a state Children’s Health Insurance Program plan and coverage is terminated as a result of loss of eligibility for that coverage.  The employer that is sponsoring the other qualified group health plan coverage ceases to make employer contributions for the other group health plan coverage.  The employee or the eligible dependents (including a spouse) exhaust their continuation of group coverage under the other qualified group health plan.  The prior qualified health plan was terminated due to the insolvency of the health plan carrier. Important Note: You will not have this special enrollment right if the loss of other health plan coverage is a result of the eligible employee or the subscriber or the eligible dependent’s failure to pay the applicable premiums. New Dependents If an eligible employee gains a new spouse or other new eligible dependent(s) due to marriage, adoption, placement for adoption, or birth, the employee and the spouse and/or the new dependent(s) may enroll for coverage in this health plan under a group contract. (If the new dependent is gained by birth, adoption, or placement for adoption, enrollment under the group contract will be retroactive to the date of birth or the date of adoption or the date of placement for adoption, provided that the enrollment time requirements described below are met.) Special Enrollment Time Requirement To exercise your special enrollment rights, you must notify your plan sponsor no later than 30 days after the date when any one of the following situations occur: the date on which the loss of your other coverage occurs or the date on which the subscriber gains a new dependent; or the date on which the subscriber receives notice that a dependent child who was not previously eligible is newly eligible for coverage as a result of changes to dependent eligibility; or the date on which you receive notice that you are newly eligible for coverage as a result of the elimination of a lifetime maximum. For example, if your coverage under another health plan is terminated, you must request enrollment for coverage in this health plan under a group contract within 30 days after your other health care coverage ends. Upon request, the plan sponsor will send you any special forms you may need. If you do not request enrollment within 30 days, you will have to wait until the group’s next open enrollment period to enroll under a group contract. You also have special enrollment rights related to termination of coverage under a state Children’s Health Insurance Program plan or a Medicaid plan or eligibility for assistance under a Medicaid plan or a state Children’s Health Insurance Program plan. When this situation applies, you must notify your plan sponsor to request coverage no later than 60 days after the coverage terminates or the employee or eligible dependent is determined to be eligible for assistance.