Common use of Enrollment Requirement Clause in Contracts

Enrollment Requirement. An Employee must enroll his or her eligible Dependents in order for them to be covered under this Contract. [Xxxxxxx] considers an eligible Dependent to be a Late Enrollee, if the Employee: enrolls a Dependent [and agrees to make the required payments] more than [30] days after the Dependent's Eligibility Date; in the case of a Newly Acquired Dependent, has other eligible Dependents whose coverage previously ended because the Employee failed to make the required contributions, or otherwise chose to end such coverage. If the Employee's dependent coverage ends for any reason, including failure to make the required payments, his or her Dependents will be considered Late Enrollees when their coverage begins again. When an Employee initially waives coverage for a spouse and/or eligible Dependent children under this Contract, the Plan Sponsor [or We] should notify the Employee of the requirement for the Employee to make a statement that waiver was because the spouse and/or eligible Dependent children were covered under another group plan, if such other coverage was in fact the reason for the waiver, and the consequences of that requirement. If the Employee previously waived coverage for the Employee's spouse or eligible Dependent children under this Contract and stated at that time that such waiver was because they were covered under another group plan, and the Employee now elects to enroll them in this Contract, the Dependent will not be considered a Late Enrollee, provided the Dependent's coverage under the other plan ends due to one of the following events: termination of employment or eligibility; reduction in the number of hours of employment; involuntary termination; divorce or legal separation [or termination of the domestic partnership]; death of the Employee's spouse; termination of the contribution toward coverage that was being made by the employer that offered the group plan under which the Dependent was covered; or termination of the other plan's coverage. But, the Employee's spouse or eligible Dependent children must be enrolled by the Employee within 90 days of the date that any of the events described above occur. Coverage will take effect as of the date the applicable event occurs. And, We will not consider an Employee's spouse or eligible Dependent children for which the Employee initially waived coverage under this Contract, to be a Late Enrollee, if: the Employee is under legal obligation to provide coverage due to a court order; and the Employee's spouse or eligible Dependent children are enrolled by the Employee within 30 days of the issuance of the court order. Coverage will take effect as of the date required pursuant to the court order. In addition, if an Employee initially waived coverage under this Contract for the Employee's spouse or eligible Dependent children because the spouse and/or Dependent children had coverage under a Consolidated Omnibus Budget Reconciliation Act (COBRA) continuation provision and the Employee requests coverage for the spouse and/or Dependent children under this Contract within 30 days of the date the COBRA continuation ended, We will not consider the spouse and/or Dependent children to be Late Enrollees. Coverage will take effect as of the date the COBRA continuation ended. When Dependent Coverage Starts In order for an Employee's dependent coverage to begin the Employee must already be covered for Employee coverage or enroll for Employee and Dependent coverage at the same time. Subject to all of the terms of this Contract, the date an Employee's dependent coverage starts depends on when the Employee elects to enroll the Employee's Initial Dependents[ and agrees to make any required payments]. If the Employee does this within [30] days of the Dependent's Eligibility Date, the Dependent's Coverage is scheduled to start on the later of: the [first day of the calendar month following the] Dependent's Eligibility Date, or the date the Employee becomes insured for Employee coverage. [Note to Carriers: Include the bracketed text in item a) for SHOP policies.] If the Employee does this more than [30] days after the Dependent's Eligibility Date, We will consider the Dependent a Late Enrollee. An Employee may elect to cover a Dependent who is a Late Enrollee during the Employee Open Enrollment Period. Coverage will take effect on the Contractholder’s Contract Anniversary date following enrollment. Once an Employee has dependent coverage for Initial Dependents, the Employee must notify Us of a Newly Acquired Dependent within the [30] days after the Newly Acquired Dependent's Eligibility Date. If the Employee does not, the Newly Acquired Dependent is a Late Enrollee. A Newly Acquired Dependent other than a newborn child or newly adopted child, including a child placed for adoption, will be covered from the later of: the date the Employee notifies Us [ and agrees to make any additional payments], or the [first day of the calendar month following the] Dependent's Eligibility Date for the Newly Acquired Dependent. [Note to Carriers: Include the bracketed text in item b) for SHOP policies.] If the Contractholder who purchased this Contract purchased it to replace a plan the Contractholder had with some other carrier, a Dependent who is Totally Disabled on the date this Contract takes effect will initially be eligible for limited coverage under this Contract if: the Dependent was validly covered under the Contractholder’s old plan on the date the Contractholder’s old plan ended; and this Contract takes effect immediately upon termination of the prior plan. The coverage under this Contract will be limited to coverage for services or supplies for conditions other than the disabling condition. Such limited coverage under this Contract will end one year from the date the person’s coverage under this Contract begins. Coverage for services or supplies for the disabling condition will be provided as stated in an extended health benefits, or like provision, contained in the Contractholder’s old plan. Thereafter, coverage will not be limited as described in this provision, but will be subject to the terms and conditions of this Contract.

Enrollment Requirement. An We will not cover the Employee must enroll his or her eligible Dependents in order for them to be covered under this Contract. [Xxxxxxx] considers an eligible Dependent to be a Late Enrollee, if until the Employee: Employee enrolls a Dependent [and agrees to make the required payments, if any. If the Employee does this within [30] days of the Employee's Eligibility Date, coverage will start on the Employee's Eligibility Date. If the Employee enrolls and agrees to make the required payments, if any: more than [30] days after the DependentEmployee's Eligibility Date; in or after the case of a Newly Acquired Dependent, has other eligible Dependents whose Employee previously had coverage previously which ended because the Employee failed to make a required payment, We will consider the required contributions, or otherwise chose Employee to end such coveragebe a Late Enrollee. If Late enrollees may request enrollment during the Employee's dependent coverage ends for any reason, including failure to make Employee Open Enrollment Period. Coverage will take effect on the required payments, his or her Dependents will be considered Late Enrollees when their coverage begins againContractholder’s Contract Anniversary date following enrollment. Special Enrollment Rules When an Employee initially waives coverage for a spouse and/or eligible Dependent children under this Contract, the Plan Sponsor [or We] should notify the Employee of the requirement for the Employee to make a statement that waiver was because the spouse and/or eligible Dependent children were he or she was covered under another group plan, if such other coverage was in fact the reason for the waiver, and the consequences of that requirement. If the an Employee previously initially waived coverage for the Employee's spouse or eligible Dependent children under this Contract and the Employee stated at that time that such waiver was because they were he or she was covered under another group plan, and the Employee now elects to enroll them in under this Contract, the Dependent We will not consider the Employee [and his or her Dependents] to be considered a [a] Late Enrollee, Enrollee[s],and will assign an effective date consistent with the provisions that follow provided the Dependent's coverage under the other plan ends due to one of the following events: termination of employment or eligibility; reduction in the number of hours of employment; involuntary termination; divorce or legal separation or dissolution of the civil union [or termination of the domestic partnership]; death of the Employee's spouse; termination of the Employer’s contribution toward coverage that was being made by the employer that offered the group plan under which the Dependent was coveredcoverage; or termination of the other plan's coverage. But, the Employee's spouse or eligible Dependent children Employee must be enrolled by the Employee enroll under this Contract within 90 days of the date that any of the events described above occur. Coverage will take effect as of the date the applicable event occurs. And, We will not consider an Employee's spouse or eligible Dependent children for which the Employee initially waived coverage under this Contract, to be a Late Enrollee, if: the Employee is under legal obligation to provide coverage due to a court order; and the Employee's spouse or eligible Dependent children are enrolled by the Employee within 30 days of the issuance of the court order. Coverage will take effect as of the date required pursuant to the court order. In addition, if If an Employee initially waived coverage under this Contract for the Employee's spouse because he or eligible Dependent children because the spouse and/or Dependent children she had coverage under a Consolidated Omnibus Budget Reconciliation Act (COBRA) continuation provision and the Employee requests coverage for the spouse and/or Dependent children under this Contract within 30 days of the date the COBRA continuation ended, We will not consider the spouse and/or Dependent children Employee to be a Late EnrolleesEnrollee. Coverage will take effect as of the date the COBRA continuation ended. When Dependent Coverage Starts In order for addition, an Employee's dependent coverage to begin Employee [and any Dependents] will not be considered [a] Late Enrollee[s] if the Employee must already be covered for Employee coverage or enroll for Employee is employed by an employer which offers multiple Health Benefits Plans and Dependent coverage at the same time. Subject to all of the terms of this Contract, the date an Employee's dependent coverage starts depends on when the Employee elects a different plan during the open enrollment period. [Further, an Employee and his or her Dependent spouse, if any, will not be considered Late Enrollees because the Employee initially waived coverage under this Contract for himself or herself and any then existing Dependents provided the Employee enrolls to cover himself or herself and his or her existing Dependent spouse, if any, under this Contract within 30 days of the marriage, birth, adoption or placement for adoption of a Newly Acquired Dependent.] If an Employee [or any Dependent] experiences a Triggering Event the Employee [and Dependents] may elect to enroll during the Employee's Initial Dependents[ and agrees to make any required payments]Special Enrollment Period that follows the Triggering Event. The election period is generally the 30 day period following the Triggering Event. If the Employee does this within [30] days Triggering Event is losing or gaining eligibility for Medicaid or NJ Family Care, the election period is 60 days. If the Triggering Event is marriage, birth, adoption, placement for adoption, or placement in xxxxxx care, coverage will take effect as of the Dependent's Eligibility Datedate of the marriage, birth, adoption, placement for adoption, or placement in xxxxxx care. If the Dependent's Coverage Triggering Event is scheduled to start on loss of minimum essential coverage the later of: effective date will be the [first day of the calendar following month. If the triggering event is loss of minimum essential coverage the effective date may be as early as the day after the loss of minimum essential coverage. For all other Triggering Events, coverage will take effect as of the first of the month following thereceipt of the enrollment form. [Note to carriers: The above Triggering Event paragraph applies to non-SHOP policies.] If an Employee [or any Dependent's Eligibility Date] experiences a Triggering Event the Employee [and Dependents] may elect to enroll during the Special Enrollment Period that follows the Triggering Event. The election period is generally the 30 day period following the Triggering Event. If the Triggering Event is losing or gaining eligibility for Medicaid or NJ Family Care, the election period is 60 days. If the Triggering Event is marriage, coverage will take effect as of the first day of the following month. If the triggering event is birth, adoption, placement for adoption, or placement in xxxxxx care, coverage will take effect as of the date of the, birth, adoption, placement for adoption, or placement in xxxxxx care. If the Triggering Event is loss of minimum essential coverage the effective date will be the first day of the following month. For all other Triggering Events, the effective date will be as assigned by the federal government and will depend on the circumstance and the date the Employee becomes insured for Employee coverageapplication is received. [Note to carriers: The above Triggering Event paragraph applies to SHOP policies.] [The [Orientation Period and ]Waiting Period This Contract has [an Orientation Period and] the following Waiting Periods: Employees in an eligible class on the Effective Date, who [have competed the Orientation Period and who] have completed at least [90 days] [60 days] [Note to Carriers: Include Use 60 day maximum for SHOP]of Full-Time service with the bracketed text Contractholder by that date, are covered under this Contract from the Effective Date. [Employees in item a) for SHOP policies.] If an eligible class on the Employee does this more than [30] days after the Dependent's Eligibility Effective Date, We will consider who [are completing or have completed the Dependent a Late Enrollee. An Employee may elect to cover a Dependent who is a Late Enrollee during the Employee Open Enrollment Period. Coverage will take effect on the Contractholder’s Contract Anniversary date following enrollment. Once an Employee has dependent coverage for Initial Dependents, the Employee must notify Us Orientation Period but who] have not completed at least [90 days] of a Newly Acquired Dependent within the [30] days after the Newly Acquired Dependent's Eligibility Date. If the Employee does not, the Newly Acquired Dependent is a Late Enrollee. A Newly Acquired Dependent other than a newborn child or newly adopted child, including a child placed for adoption, will be covered from the later of: the date the Employee notifies Us [ and agrees to make any additional payments], or the [first day of the calendar month following the] Dependent's Eligibility Date for the Newly Acquired Dependent. [Note to Carriers: Include the bracketed text in item b) for SHOP policies.] If Full-Time service with the Contractholder who purchased this Contract purchased it to replace a plan the Contractholder had with some other carrierby that date, a Dependent who is Totally Disabled on the date this Contract takes effect will initially be are eligible for limited coverage under this Contract iffrom the day after Employees complete [90 days] of Full-Time service.] [Note to carriers: Omit for SHOP policies] [Employees who enter an eligible class after the Dependent was validly covered under Effective Date [who have completed the Contractholder’s old plan on the date the Contractholder’s old plan ended; and this Contract takes effect immediately upon termination of the prior plan. The Orientation Period] are eligible for coverage under this Contract will be limited from the day after Employees complete [90 days] of Full-Time service with the Contractholder.] [Note to coverage carriers: Applies to non-SHOP policies] [Employees who enter an eligible class after the Effective Date [who have completed the Orientation Period] are eligible for services or supplies for conditions other than the disabling condition. Such limited coverage under this Contract as of the first of the month following [15 or 30 or 45 or 60 days] of Full-Time service with the Contractholder.] [Note to carriers: Applies to -SHOP policies]] Multiple Employment If an Employee works for both the Contractholder and a covered Affiliated Company, or for more than one covered Affiliated Company, We will end treat the Employee as if only one year from entity employs the date the person’s Employee. And such an Employee will not have multiple coverage under this Contract. But, if this Contract begins. Coverage uses the amount of an Employee’s earnings or number of work hours to determine class, or for services any other reason, such Employee’s earnings or supplies for the disabling condition number of work hours will be provided figured as stated in an extended health benefits, the sum of his or like provision, contained in the Contractholder’s old plan. Thereafter, coverage will not be limited as described in this provision, but will be subject to the terms and conditions her earnings or number of this Contractwork hours from all Affiliated Companies.

Enrollment Requirement. An We will not cover the Employee must enroll his or her eligible Dependents in order for them to be covered under this Contract. [Xxxxxxx] considers an eligible Dependent to be a Late Enrollee, if until the Employee: Employee enrolls a Dependent [and agrees to make the required payments, if any. If the Employee does this within [30] days of the Employee's Eligibility Date, coverage will start on the Employee's Eligibility Date. If the Employee enrolls and agrees to make the required payments, if any: more than [30] days after the DependentEmployee's Eligibility Date; in or after the case of a Newly Acquired Dependent, has other eligible Dependents whose Employee previously had coverage previously which ended because the Employee failed to make a required payment, We will consider the required contributions, or otherwise chose Employee to end such coveragebe a Late Enrollee. If Late enrollees may request enrollment during the Employee's dependent coverage ends for any reason, including failure to make Employee Open Enrollment Period. Coverage will take effect on the required payments, his or her Dependents will be considered Late Enrollees when their coverage begins againContractholder’s Contract Anniversary date following enrollment. Special Enrollment Rules When an Employee initially waives coverage for a spouse and/or eligible Dependent children under this Contract, the Plan Sponsor [or We] should notify the Employee of the requirement for the Employee to make a statement that waiver was because the spouse and/or eligible Dependent children were he or she was covered under another group plan, if such other coverage was in fact the reason for the waiver, and the consequences of that requirement. If the an Employee previously initially waived coverage for the Employee's spouse or eligible Dependent children under this Contract and the Employee stated at that time that such waiver was because they were he or she was covered under another group plan, and the Employee now elects to enroll them in under this Contract, the Dependent We will not consider the Employee [and his or her Dependents] to be considered a [a] Late Enrollee, Enrollee[s],and will assign an effective date consistent with the provisions that follow provided the Dependent's coverage under the other plan ends due to one of the following events: termination of employment or eligibility; reduction in the number of hours of employment; involuntary termination; divorce or legal separation or dissolution of the civil union [or termination of the domestic partnership]; death of the Employee's spouse; termination of the Employer’s contribution toward coverage that was being made by the employer that offered the group plan under which the Dependent was coveredcoverage; or termination of the other plan's coverage. But, the Employee's spouse or eligible Dependent children Employee must be enrolled by the Employee enroll under this Contract within 90 days of the date that any of the events described above occur. Coverage will take effect as of the date the applicable event occurs. And, We will not consider an Employee's spouse or eligible Dependent children for which the Employee initially waived coverage under this Contract, to be a Late Enrollee, if: the Employee is under legal obligation to provide coverage due to a court order; and the Employee's spouse or eligible Dependent children are enrolled by the Employee within 30 days of the issuance of the court order. Coverage will take effect as of the date required pursuant to the court order. In addition, if If an Employee initially waived coverage under this Contract for the Employee's spouse because he or eligible Dependent children because the spouse and/or Dependent children she had coverage under a Consolidated Omnibus Budget Reconciliation Act (COBRA) continuation provision and the Employee requests coverage for the spouse and/or Dependent children under this Contract within 30 days of the date the COBRA continuation ended, We will not consider the spouse and/or Dependent children Employee to be a Late EnrolleesEnrollee. Coverage will take effect as of the date the COBRA continuation ended. When Dependent Coverage Starts In order for addition, an Employee's dependent coverage to begin Employee [and any Dependents] will not be considered [a] Late Enrollee[s] if the Employee must already be covered for Employee coverage or enroll for Employee is employed by an employer which offers multiple Health Benefits Plans and Dependent coverage at the same time. Subject to all of the terms of this Contract, the date an Employee's dependent coverage starts depends on when the Employee elects a different plan during the open enrollment period. [Further, an Employee and his or her Dependent spouse, if any, will not be considered Late Enrollees because the Employee initially waived coverage under this Contract for himself or herself and any then existing Dependents provided the Employee enrolls to cover himself or herself and his or her existing Dependent spouse, if any, under this Contract within 30 days of the marriage, birth, adoption or placement for adoption of a Newly Acquired Dependent.] If an Employee [or any Dependent] experiences a Triggering Event the Employee [and Dependents] may elect to enroll during the Employee's Initial Dependents[ and agrees to make any required payments]Special Enrollment Period that follows the Triggering Event. The election period is generally the 30 day period following the Triggering Event. If the Employee does this within [30] days Triggering Event is losing or gaining eligibility for Medicaid or NJ Family Care, the election period is 60 days. If the Triggering Event is marriage, birth, adoption, placement for adoption, or placement in xxxxxx care, coverage will take effect as of the date of the marriage, birth, adoption, placement for adoption, or placement in xxxxxx care. For all other Triggering Events, coverage will take effect as of the first of the month following receipt of the enrollment form. [Note to carriers: The above Triggering Event paragraph applies to non-SHOP policies.] If an Employee [or any Dependent's Eligibility Date] experiences a Triggering Event the Employee [and Dependents] may elect to enroll during the Special Enrollment Period that follows the Triggering Event. The election period is generally the 30 day period following the Triggering Event. If the Triggering Event is losing or gaining eligibility for Medicaid or NJ Family Care, the Dependent's Coverage election period is scheduled to start on 60 days. If the later of: Triggering Event is marriage, coverage will take effect as of the [first day of the calendar month following the] Dependent's Eligibility Datemonth. If the triggering event is birth, adoption, placement for adoption, or placement in xxxxxx care, coverage will take effect as of the date of the, birth, adoption, placement for adoption, or placement in xxxxxx care. If the Triggering Event is loss of minimum essential coverage the effective date will be the first day of the following month. For all other Triggering Events, the effective date will be as assigned by the federal government and will depend on the circumstance and the date the Employee becomes insured for Employee coverageapplication is received. [Note to carriers: The above Triggering Event paragraph applies to SHOP policies.] [The [Orientation Period and ]Waiting Period This Contract has [an Orientation Period and] the following Waiting Periods: Employees in an eligible class on the Effective Date, who [have competed the Orientation Period and who] have completed at least [90 days] [60 days] [Note to Carriers: Include Use 60 day maximum for SHOP]of Full-Time service with the bracketed text Contractholder by that date, are covered under this Contract from the Effective Date. [Employees in item a) for SHOP policies.] If an eligible class on the Employee does this more than [30] days after the Dependent's Eligibility Effective Date, We will consider who [are completing or have completed the Dependent a Late Enrollee. An Employee may elect to cover a Dependent who is a Late Enrollee during the Employee Open Enrollment Period. Coverage will take effect on the Contractholder’s Contract Anniversary date following enrollment. Once an Employee has dependent coverage for Initial Dependents, the Employee must notify Us Orientation Period but who] have not completed at least [90 days] of a Newly Acquired Dependent within the [30] days after the Newly Acquired Dependent's Eligibility Date. If the Employee does not, the Newly Acquired Dependent is a Late Enrollee. A Newly Acquired Dependent other than a newborn child or newly adopted child, including a child placed for adoption, will be covered from the later of: the date the Employee notifies Us [ and agrees to make any additional payments], or the [first day of the calendar month following the] Dependent's Eligibility Date for the Newly Acquired Dependent. [Note to Carriers: Include the bracketed text in item b) for SHOP policies.] If Full-Time service with the Contractholder who purchased this Contract purchased it to replace a plan the Contractholder had with some other carrierby that date, a Dependent who is Totally Disabled on the date this Contract takes effect will initially be are eligible for limited coverage under this Contract iffrom the day after Employees complete [90 days] of Full-Time service.] [Note to carriers: Omit for SHOP policies] [Employees who enter an eligible class after the Dependent was validly covered under Effective Date [who have completed the Contractholder’s old plan on the date the Contractholder’s old plan ended; and this Contract takes effect immediately upon termination of the prior plan. The Orientation Period] are eligible for coverage under this Contract will be limited from the day after Employees complete [90 days] of Full-Time service with the Contractholder.] [Note to coverage carriers: Applies to non-SHOP policies] [Employees who enter an eligible class after the Effective Date [who have completed the Orientation Period] are eligible for services or supplies for conditions other than the disabling condition. Such limited coverage under this Contract as of the first of the month following [15 or 30 or 45 or 60 days] of Full-Time service with the Contractholder.] [Note to carriers: Applies to -SHOP policies]] Multiple Employment If an Employee works for both the Contractholder and a covered Affiliated Company, or for more than one covered Affiliated Company, We will end treat the Employee as if only one year from entity employs the date the person’s Employee. And such an Employee will not have multiple coverage under this Contract. But, if this Contract begins. Coverage uses the amount of an Employee’s earnings or number of work hours to determine class, or for services any other reason, such Employee’s earnings or supplies for the disabling condition number of work hours will be provided figured as stated in an extended health benefits, the sum of his or like provision, contained in the Contractholder’s old plan. Thereafter, coverage will not be limited as described in this provision, but will be subject to the terms and conditions her earnings or number of this Contractwork hours from all Affiliated Companies.

Enrollment Requirement. An We will not cover the Employee must enroll his or her eligible Dependents in order for them to be covered under this Contract. [Xxxxxxx] considers an eligible Dependent to be a Late Enrollee, if until the Employee: Employee enrolls a Dependent [and agrees to make the required payments, if any. If the Employee does this within [30] days of the Employee's Eligibility Date, coverage will start on the Employee's Eligibility Date. If the Employee enrolls and agrees to make the required payments, if any: more than [30] days after the DependentEmployee's Eligibility Date; in or after the case of a Newly Acquired Dependent, has other eligible Dependents whose Employee previously had coverage previously which ended because the Employee failed to make a required payment, We will consider the required contributions, or otherwise chose Employee to end such coveragebe a Late Enrollee. If Late enrollees may request enrollment during the Employee's dependent coverage ends for any reason, including failure to make Employee Open Enrollment Period. Coverage will take effect on the required payments, his or her Dependents will be considered Late Enrollees when their coverage begins againContractholder’s Contract Anniversary date following enrollment. Special Enrollment Rules When an Employee initially waives coverage for a spouse and/or eligible Dependent children under this Contract, the Plan Sponsor [or We] should notify the Employee of the requirement for the Employee to make a statement that waiver was because the spouse and/or eligible Dependent children were he or she was covered under another group plan, if such other coverage was in fact the reason for the waiver, and the consequences of that requirement. If the an Employee previously initially waived coverage for the Employee's spouse or eligible Dependent children under this Contract and the Employee stated at that time that such waiver was because they were he or she was covered under another group plan, and the Employee now elects to enroll them in under this Contract, the Dependent We will not consider the Employee [and his or her Dependents] to be considered a [a] Late Enrollee, Enrollee[s],and will assign an effective date consistent with the provisions that follow provided the Dependent's coverage under the other plan ends due to one of the following events: termination of employment or eligibility; reduction in the number of hours of employment; involuntary termination; divorce or legal separation or dissolution of the civil union [or termination of the domestic partnership]; death of the Employee's spouse; termination of the Employer’s contribution toward coverage that was being made by the employer that offered the group plan under which the Dependent was coveredcoverage; or termination of the other plan's coverage. But, the Employee's spouse or eligible Dependent children Employee must be enrolled by the Employee enroll under this Contract within 90 days of the date that any of the events described above occur. Coverage will take effect as of the date the applicable event occurs. And, We will not consider an Employee's spouse or eligible Dependent children for which the Employee initially waived coverage under this Contract, to be a Late Enrollee, if: the Employee is under legal obligation to provide coverage due to a court order; and the Employee's spouse or eligible Dependent children are enrolled by the Employee within 30 days of the issuance of the court order. Coverage will take effect as of the date required pursuant to the court order. In addition, if If an Employee initially waived coverage under this Contract for the Employee's spouse because he or eligible Dependent children because the spouse and/or Dependent children she had coverage under a Consolidated Omnibus Budget Reconciliation Act (COBRA) continuation provision and the Employee requests coverage for the spouse and/or Dependent children under this Contract within 30 days of the date the COBRA continuation ended, We will not consider the spouse and/or Dependent children Employee to be a Late EnrolleesEnrollee. Coverage will take effect as of the date the COBRA continuation ended. When In addition, an Employee [and any Dependents] will not be considered [a] Late Enrollee[s] if the Employee is employed by an employer which offers multiple Health Benefits Plans and the Employee elects a different plan during the open enrollment period. [Further, an Employee and his or her Dependent Coverage Starts In order spouse, if any, will not be considered Late Enrollees because the Employee initially waived coverage under this Contract for himself or herself and any then existing Dependents provided the Employee enrolls to cover himself or herself and his or her existing Dependent spouse, if any, under this Contract within 30 days of the marriage, birth, adoption or placement for adoption of a Newly Acquired Dependent.] If an Employee [or any Dependent] experiences a Triggering Event the Employee [and Dependents] may elect to enroll during the Special Enrollment Period that follows the Triggering Event. The election period is generally the 30 day period following the Triggering Event. If the Triggering Event is losing or gaining eligibility for Medicaid or NJ Family Care, the election period is 60 days. If the Triggering Event is marriage, birth, adoption, placement for adoption, or placement in xxxxxx care, coverage will take effect as of the date of the marriage, birth, adoption, placement for adoption, or placement in xxxxxx care. If the Triggering Event is loss of minimum essential coverage the effective date will be the first day of the following month. If the triggering event is loss of minimum essential coverage the effective date may be as early as the day after the loss of minimum essential coverage. For all other Triggering Events, coverage will take effect as of the first of the month following receipt of the enrollment form. [Note to carriers: The above Triggering Event paragraph applies to non-SHOP policies.] If an Employee [or any Dependent] experiences a Triggering Event the Employee [and Dependents] may elect to enroll during the Special Enrollment Period that follows the Triggering Event. The election period is generally the 30 day period following the Triggering Event. If the Triggering Event is losing or gaining eligibility for Medicaid or NJ Family Care, the election period is 60 days. If the Triggering Event is marriage, coverage will take effect as of the first day of the following month. If the triggering event is birth, adoption, placement for adoption, or placement in xxxxxx care, coverage will take effect as of the date of the, birth, adoption, placement for adoption, or placement in xxxxxx care. If the Triggering Event is loss of minimum essential coverage the effective date will be the first day of the following month. If the Triggering Event is confirmation of an Employee's dependent coverage to begin ’s or Spouse’s pregnancy by a Practitioner, the effective date is elected by the Employee must already be covered for Employee coverage or enroll for Employee and Dependent coverage at is either the same time. Subject to all first of the terms month in which confirmation of this Contractpregnancy is received, or the first of the month following the date an Employee's dependent coverage starts depends on when the Employee elects to enroll the Employee's Initial Dependents[ and agrees to make any required payments]enroll. If the Employee does this within [30] days of the Dependent's Eligibility DateFor all other Triggering Events, the Dependent's Coverage is scheduled to start effective date will be as assigned by the federal government and will depend on the later of: the [first day of the calendar month following the] Dependent's Eligibility Date, or circumstance and the date the Employee becomes insured for Employee coverageapplication is received. [Note to carriers: The above Triggering Event paragraph applies to SHOP policies.] [The [Orientation Period and ]Waiting Period This Contract has [an Orientation Period and] the following Waiting Periods: Employees in an eligible class on the Effective Date, who [have competed the Orientation Period and who] have completed at least [90 days] [60 days] [Note to Carriers: Include Use 60 day maximum for SHOP]of Full-Time service with the bracketed text Contractholder by that date, are covered under this Contract from the Effective Date. [Employees in item a) for SHOP policies.] If an eligible class on the Employee does this more than [30] days after the Dependent's Eligibility Effective Date, We will consider who [are completing or have completed the Dependent a Late Enrollee. An Employee may elect to cover a Dependent who is a Late Enrollee during the Employee Open Enrollment Period. Coverage will take effect on the Contractholder’s Contract Anniversary date following enrollment. Once an Employee has dependent coverage for Initial Dependents, the Employee must notify Us Orientation Period but who] have not completed at least [90 days] of a Newly Acquired Dependent within the [30] days after the Newly Acquired Dependent's Eligibility Date. If the Employee does not, the Newly Acquired Dependent is a Late Enrollee. A Newly Acquired Dependent other than a newborn child or newly adopted child, including a child placed for adoption, will be covered from the later of: the date the Employee notifies Us [ and agrees to make any additional payments], or the [first day of the calendar month following the] Dependent's Eligibility Date for the Newly Acquired Dependent. [Note to Carriers: Include the bracketed text in item b) for SHOP policies.] If Full-Time service with the Contractholder who purchased this Contract purchased it to replace a plan the Contractholder had with some other carrierby that date, a Dependent who is Totally Disabled on the date this Contract takes effect will initially be are eligible for limited coverage under this Contract iffrom the day after Employees complete [90 days] of Full-Time service.] [Note to carriers: Omit for SHOP policies] [Employees who enter an eligible class after the Dependent was validly covered under Effective Date [who have completed the Contractholder’s old plan on the date the Contractholder’s old plan ended; and this Contract takes effect immediately upon termination of the prior plan. The Orientation Period] are eligible for coverage under this Contract will be limited from the day after Employees complete [90 days] of Full-Time service with the Contractholder.] [Note to coverage carriers: Applies to non-SHOP policies] [Employees who enter an eligible class after the Effective Date [who have completed the Orientation Period] are eligible for services or supplies for conditions other than the disabling condition. Such limited coverage under this Contract as of the first of the month following [15 or 30 or 45 or 60 days] of Full-Time service with the Contractholder.] [Note to carriers: Applies to -SHOP policies]] Multiple Employment If an Employee works for both the Contractholder and a covered Affiliated Company, or for more than one covered Affiliated Company, We will end treat the Employee as if only one year from entity employs the date the person’s Employee. And such an Employee will not have multiple coverage under this Contract. But, if this Contract begins. Coverage uses the amount of an Employee’s earnings or number of work hours to determine class, or for services any other reason, such Employee’s earnings or supplies for the disabling condition number of work hours will be provided figured as stated in an extended health benefits, the sum of his or like provision, contained in the Contractholder’s old plan. Thereafter, coverage will not be limited as described in this provision, but will be subject to the terms and conditions her earnings or number of this Contractwork hours from all Affiliated Companies.

Enrollment Requirement. An Employee must enroll his or her eligible Dependents in order for them to be covered under this Contract. [Xxxxxxx] considers an eligible Dependent to be a Late Enrollee, if the Employee: enrolls a Dependent [and agrees to make the required payments] more than [30] days after the Dependent's Eligibility Date; in the case of a Newly Acquired Dependent, has other eligible Dependents whose coverage previously ended because the Employee failed to make the required contributions, or otherwise chose to end such coverage. If the Employee's dependent coverage ends for any reason, including failure to make the required payments, his or her Dependents will be considered Late Enrollees when their coverage begins again. When an Employee initially waives coverage for a spouse and/or eligible Dependent children under this Contract, the Plan Sponsor [or We] should notify the Employee of the requirement for the Employee to make a statement that waiver was because the spouse and/or eligible Dependent children were covered under another group plan, if such other coverage was in fact the reason for the waiver, and the consequences of that requirement. If the Employee previously waived coverage for the Employee's spouse or eligible Dependent children under this Contract and stated at that time that such waiver was because they were covered under another group plan, and the Employee now elects to enroll them in this Contract, the Dependent will not be considered a Late Enrollee, provided the Dependent's coverage under the other plan ends due to one of the following events: termination of employment or eligibility; reduction in the number of hours of employment; involuntary termination; divorce or legal separation [or termination of the domestic partnership]; death of the Employee's spouse; termination of the contribution toward coverage that was being made by the employer that offered the group plan under which the Dependent was covered; or termination of the other plan's coverage. But, the Employee's spouse or eligible Dependent children must be enrolled by the Employee within 90 days of the date that any of the events described above occur. Coverage will take effect as of the date the applicable event occurs. And, We will not consider an Employee's spouse or eligible Dependent children for which the Employee initially waived coverage under this Contract, to be a Late Enrollee, if: the Employee is under legal obligation to provide coverage due to a court order; and the Employee's spouse or eligible Dependent children are enrolled by the Employee within 30 days of the issuance of the court order. Coverage will take effect as of the date required pursuant to the court order. In addition, if an Employee initially waived coverage under this Contract for the Employee's spouse or eligible Dependent children because the spouse and/or Dependent children had coverage under a Consolidated Omnibus Budget Reconciliation Act (COBRA) continuation provision and the Employee requests coverage for the spouse and/or Dependent children under this Contract within 30 days of the date the COBRA continuation ended, We will not consider the spouse and/or Dependent children to be Late Enrollees. Coverage will take effect as of the date the COBRA continuation ended. When Dependent Coverage Starts In order for an Employee's dependent coverage to begin the Employee must already be covered for Employee coverage or enroll for Employee and Dependent coverage at the same time. Subject to all of the terms of this Contract, the date an Employee's dependent coverage starts depends on when the Employee elects to enroll the Employee's Initial Dependents[ and agrees to make any required payments]. If the Employee does this within [30] days of the Dependent's Eligibility Date, the Dependent's Coverage is scheduled to start on the later of: the [first day of the calendar month following the] Dependent's Eligibility Date, or the date the Employee becomes insured for Employee coverage. [Note to Carriers: Include the bracketed text in item a) for SHOP policies.] If the Employee does this more than [30] days after the Dependent's Eligibility Date, We will consider the Dependent a Late Enrollee. An Employee may elect to cover a Dependent who is a Late Enrollee during the Employee Open Enrollment Period. Coverage will take effect on the Contractholder’s Contract Anniversary date following enrollment. Once an Employee has dependent coverage for Initial Dependents, the Employee must notify Us of a Newly Acquired Dependent within the [30] days after the Newly Acquired Dependent's Eligibility Date. If the Employee does not, the Newly Acquired Dependent is a Late Enrollee. A Newly Acquired Dependent other than a newborn child or newly adopted child, including a child placed for adoption, will be covered from the later of: the date the Employee notifies Us [ and agrees to make any additional payments], or the [first day of the calendar month following the] Dependent's Eligibility Date for the Newly Acquired Dependent. [Note to Carriers: Include the bracketed text in item b) for SHOP policies.] If the Contractholder who purchased this Contract purchased it to replace a plan the Contractholder had with some other carrier, a Dependent who is Totally Disabled on the date this Contract takes effect will initially be eligible for limited coverage under this Contract if: the Dependent was validly covered under the Contractholder’s old plan on the date the Contractholder’s old plan ended; and this Contract takes effect immediately upon termination of the prior plan. The coverage under this Contract will be limited to coverage for services or supplies for conditions other than the disabling condition. Such limited coverage under this Contract will end one year from the date the person’s coverage under this Contract begins. Coverage for services or supplies for the disabling condition will be provided as stated in an extended health benefits, or like provision, contained in the Contractholder’s old plan. Thereafter, coverage will not be limited as described in this provision, but will be subject to the terms and conditions of this Contract.

Enrollment Requirement. An Employee must enroll his or her eligible Dependents in order for them to be covered under this Contract. [Xxxxxxx] considers an eligible Dependent to be a Late Enrollee, if the Employee: enrolls a Dependent [and agrees to make the required payments] more than [30] days after the Dependent's Eligibility Date; in the case of a Newly Acquired Dependent, has other eligible Dependents whose coverage previously ended because the Employee failed to make the required contributions, or otherwise chose to end such coverage. If the Employee's dependent coverage ends for any reason, including failure to make the required payments, his or her Dependents will be considered Late Enrollees when their coverage begins again. When an Employee initially waives coverage for a spouse and/or eligible Dependent children under this Contract, the Plan Sponsor [or We] should notify the Employee of the requirement for the Employee to make a statement that waiver was because the spouse and/or eligible Dependent children were covered under another group plan, if such other coverage was in fact the reason for the waiver, and the consequences of that requirement. If the Employee previously waived coverage for the Employee's spouse or eligible Dependent children under this Contract and stated at that time that such waiver was because they were covered under another group plan, and the Employee now elects to enroll them in this Contract, the Dependent will not be considered a Late Enrollee, provided the Dependent's coverage under the other plan ends due to one of the following events: termination of employment or eligibility; reduction in the number of hours of employment; involuntary termination; divorce or legal separation [or termination of the domestic partnership]; death of the Employee's spouse; termination of the contribution toward coverage that was being made by the employer that offered the group plan under which the Dependent was covered; or termination of the other plan's coverage. But, the Employee's spouse or eligible Dependent children must be enrolled by the Employee within 90 days of the date that any of the events described above occur. Coverage will take effect as of the date the applicable event occurs. And, We will not consider an Employee's spouse or eligible Dependent children for which the Employee initially waived coverage under this Contract, to be a Late Enrollee, if: the Employee is under legal obligation to provide coverage due to a court order; and the Employee's spouse or eligible Dependent children are enrolled by the Employee within 30 days of the issuance of the court order. Coverage will take effect as of the date required pursuant to the court order. In addition, if an Employee initially waived coverage under this Contract for the Employee's spouse or eligible Dependent children because the spouse and/or Dependent children had coverage under a Consolidated Omnibus Budget Reconciliation Act (COBRA) continuation provision and the Employee requests coverage for the spouse and/or Dependent children under this Contract within 30 days of the date the COBRA continuation ended, We will not consider the spouse and/or Dependent children to be Late Enrollees. Coverage will take effect as of the date the COBRA continuation ended. When Dependent Coverage Starts In order for an Employee's dependent coverage to begin the Employee must already be covered for Employee coverage or enroll for Employee and Dependent coverage at the same time. Subject to all of the terms of this Contract, the date an Employee's dependent coverage starts depends on when the Employee elects to enroll the Employee's Initial Dependents[ and agrees to make any required payments]. If the Employee does this within [30] days of the Dependent's Eligibility Date, the Dependent's Coverage is scheduled to start on the later of: the [first day of the calendar month following the] Dependent's Eligibility Date, or the date the Employee becomes insured covered for Employee coverage. [Note to Carriers: Include the bracketed text in item a) for SHOP policies.] If the Employee does this more than [30] days after the Dependent's Eligibility Date, We will consider the Dependent a Late Enrollee. An Employee may elect to cover a Dependent who is a Late Enrollee during the Employee Open Enrollment Period. Coverage will take effect on the Contractholder’s Contract Anniversary date following enrollment. Once an Employee has dependent coverage for Initial Dependents, the Employee must notify Us of a Newly Acquired Dependent within the [30] days after the Newly Acquired Dependent's Eligibility Date. If the Employee does not, the Newly Acquired Dependent is a Late Enrollee. A Newly Acquired Dependent other than a newborn child or newly adopted child, including a child placed for adoption, will be covered from the later of: the date the Employee notifies Us [ and agrees to make any additional payments], or the [first day of the calendar month following the] Dependent's Eligibility Date for the Newly Acquired Dependent. [Note to Carriers: Include the bracketed text in item b) for SHOP policies.] If the Contractholder who purchased this Contract purchased it to replace a plan the Contractholder had with some other carrier, a Dependent who is Totally Disabled on the date this Contract takes effect will initially be eligible for limited coverage under this Contract if: the Dependent was validly covered under the Contractholder’s old plan on the date the Contractholder’s old plan ended; and this Contract takes effect immediately upon termination of the prior plan. The coverage under this Contract will be limited to coverage for services or supplies for conditions other than the disabling condition. Such limited coverage under this Contract will end one year from the date the person’s coverage under this Contract begins. Coverage for services or supplies for the disabling condition will be provided as stated in an extended health benefits, or like provision, contained in the Contractholder’s old plan. Thereafter, coverage will not be limited as described in this provision, but will be subject to the terms and conditions of this Contract.

Enrollment Requirement. An We will not cover the Employee must enroll his or her eligible Dependents in order for them to be covered under this Contract. [Xxxxxxx] considers an eligible Dependent to be a Late Enrollee, if until the Employee: Employee enrolls a Dependent [and agrees to make the required payments, if any. If the Employee does this within [30] days of the Employee's Eligibility Date, coverage will start on the Employee's Eligibility Date. If the Employee enrolls and agrees to make the required payments, if any: more than [30] days after the DependentEmployee's Eligibility Date; in or after the case of a Newly Acquired Dependent, has other eligible Dependents whose Employee previously had coverage previously which ended because the Employee failed to make a required payment, We will consider the required contributions, or otherwise chose Employee to end such coveragebe a Late Enrollee. If Late enrollees may request enrollment during the Employee's dependent coverage ends for any reason, including failure to make Employee Open Enrollment Period. Coverage will take effect on the required payments, his or her Dependents will be considered Late Enrollees when their coverage begins againContractholder’s Contract Anniversary date following enrollment. Special Enrollment Rules When an Employee initially waives coverage for a spouse and/or eligible Dependent children under this Contract, the Plan Sponsor [or We] should notify the Employee of the requirement for the Employee to make a statement that waiver was because the spouse and/or eligible Dependent children were he or she was covered under another group plan, if such other coverage was in fact the reason for the waiver, and the consequences of that requirement. If the an Employee previously initially waived coverage for the Employee's spouse or eligible Dependent children under this Contract and the Employee stated at that time that such waiver was because they were he or she was covered under another group plan, and the Employee now elects to enroll them in under this Contract, the Dependent We will not consider the Employee [and his or her Dependents] to be considered a [a] Late Enrollee, Enrollee[s],and will assign an effective date consistent with the provisions that follow provided the Dependent's coverage under the other plan ends due to one of the following events: termination of employment or eligibility; reduction in the number of hours of employment; involuntary termination; divorce or legal separation or dissolution of the civil union [or termination of the domestic partnership]; death of the Employee's spouse; termination of the Employer’s contribution toward coverage that was being made by the employer that offered the group plan under which the Dependent was coveredcoverage; or termination of the other plan's coverage. But, the Employee's spouse or eligible Dependent children Employee must be enrolled by the Employee enroll under this Contract within 90 days of the date that any of the events described above occur. Coverage will take effect as of the date the applicable event occurs. And, We will not consider an Employee's spouse or eligible Dependent children for which the Employee initially waived coverage under this Contract, to be a Late Enrollee, if: the Employee is under legal obligation to provide coverage due to a court order; and the Employee's spouse or eligible Dependent children are enrolled by the Employee within 30 days of the issuance of the court order. Coverage will take effect as of the date required pursuant to the court order. In addition, if If an Employee initially waived coverage under this Contract for the Employee's spouse because he or eligible Dependent children because the spouse and/or Dependent children she had coverage under a Consolidated Omnibus Budget Reconciliation Act (COBRA) continuation provision and the Employee requests coverage for the spouse and/or Dependent children under this Contract within 30 days of the date the COBRA continuation ended, We will not consider the spouse and/or Dependent children Employee to be a Late EnrolleesEnrollee. Coverage will take effect as of the date the COBRA continuation ended. When Dependent Coverage Starts In order for addition, an Employee's dependent coverage to begin Employee [and any Dependents] will not be considered [a] Late Enrollee[s] if the Employee must already be covered for Employee coverage or enroll for Employee is employed by an employer which offers multiple Health Benefits Plans and Dependent coverage at the same time. Subject to all of the terms of this Contract, the date an Employee's dependent coverage starts depends on when the Employee elects a different plan during the open enrollment period. [Further, an Employee and his or her Dependent spouse, if any, will not be considered Late Enrollees because the Employee initially waived coverage under this Contract for himself or herself and any then existing Dependents provided the Employee enrolls to cover himself or herself and his or her existing Dependent spouse, if any, under this Contract within 30 days of the marriage, birth, adoption or placement for adoption of a Newly Acquired Dependent.] If an Employee [or any Dependent] experiences a Triggering Event the Employee [and Dependents] may elect to enroll during the Employee's Initial Dependents[ and agrees to make any required payments]Special Enrollment Period that follows the Triggering Event. The election period is generally the 30 day period following the Triggering Event. If the Employee does this within [30] days Triggering Event is losing or gaining eligibility for Medicaid or NJ Family Care, the election period is 60 days. If the Triggering Event is marriage, birth, adoption, placement for adoption, or placement in xxxxxx care, coverage will take effect as of the date of the marriage, birth, adoption, placement for adoption, or placement in xxxxxx care. For all other Triggering Events, coverage will take effect as of the first of the month following receipt of the enrollment form. [Note to carriers: The above Triggering Event paragraph applies to non-SHOP policies.] If an Employee [or any Dependent's Eligibility Date] experiences a Triggering Event the Employee [and Dependents] may elect to enroll during the Special Enrollment Period that follows the Triggering Event. The election period is generally the 30 day period following the Triggering Event. If the Triggering Event is losing or gaining eligibility for Medicaid or NJ Family Care, the Dependent's Coverage election period is scheduled to start on 60 days. If the later of: Triggering Event is marriage, coverage will take effect as of the [first day of the calendar month following the] Dependent's Eligibility Datemonth. If the triggering event is birth, adoption, placement for adoption, or placement in xxxxxx care, coverage will take effect as of the date of the, birth, adoption, placement for adoption, or placement in xxxxxx care. If the Triggering Event is loss of minimum essential coverage the effective date will be the first day of the following month. For all other Triggering Events, the effective date will be as assigned by the federal government and will depend on the circumstance and the date the Employee becomes insured for Employee coverageapplication is received. [Note to carriers: The above Triggering Event paragraph applies to SHOP policies.] [The Waiting Period This Contract has the following waiting periods: Employees in an eligible class on the Effective Date, who have completed at least [90 days] [60 days] [Note to Carriers: Include the bracketed text in item a) Use 60 day maximum for SHOP policies.] If the Employee does this more than [30] days after the Dependent's Eligibility Date, We will consider the Dependent a Late Enrollee. An Employee may elect to cover a Dependent who is a Late Enrollee during the Employee Open Enrollment Period. Coverage will take effect on the Contractholder’s Contract Anniversary date following enrollment. Once an Employee has dependent coverage for Initial Dependents, the Employee must notify Us of a Newly Acquired Dependent within the [30] days after the Newly Acquired Dependent's Eligibility Date. If the Employee does not, the Newly Acquired Dependent is a Late Enrollee. A Newly Acquired Dependent other than a newborn child or newly adopted child, including a child placed for adoption, will be covered from the later of: the date the Employee notifies Us [ and agrees to make any additional payments], or the [first day of the calendar month following the] Dependent's Eligibility Date for the Newly Acquired Dependent. [Note to Carriers: Include the bracketed text in item b) for SHOP policies.] If SHOP]of continuous Full-Time service with the Contractholder who purchased this Contract purchased it to replace a plan the Contractholder had with some other carrierby that date, a Dependent who is Totally Disabled on the date this Contract takes effect will initially be are eligible for limited coverage under this Contract if: the Dependent was validly covered under the Contractholder’s old plan on the date the Contractholder’s old plan ended; and this Contract takes effect immediately upon termination of the prior plan. The coverage under this Contract will be limited to coverage for services or supplies for conditions other than the disabling condition. Such limited coverage under this Contract will end one year from the date the person’s coverage under this Contract begins. Coverage for services or supplies for the disabling condition will be provided as stated in an extended health benefits, or like provision, contained in the Contractholder’s old plan. Thereafter, coverage will not be limited as described in this provision, but will be subject to the terms and conditions of this ContractEffective Date.