Open Enrollment. An Open Enrollment Period will be held each year for coverage to be effective on the first day of the plan year. You and/or your eligible dependents may enroll at this time by making written application during the open enrollment period. Special Enrollment Period After your initial effective date, you may enroll your eligible dependents for coverage through a Special Enrollment Period after you experience a change in family status, a loss of private health coverage, or a change in eligibility for Medicaid or a State Children’s Health Insurance Program (CHIP) as described below. With a change in family status, you must make written application within the thirty (30) days following the event. You and/or your eligible dependents will qualify for a Special Enrollment Period as follows: if you get married, coverage begins the first day of the month following your marriage; if you have a child born to the family, coverage begins on the date of the child’s birth; if you have a child placed for adoption with your family, coverage begins on the date the child is placed for adoption with your family. In addition, if you lose your private health coverage, you must make written application within the thirty (30) days following the event. Coverage begins the first day of the month following the loss of private health coverage. If you or your eligible dependents have a loss of coverage on the first day of the month, coverage under this agreement begins on the first day of that month. You or your eligible dependents will qualify for a Special Enrollment Period if each of the following conditions is met: The eligible person seeking coverage had other coverage at the time that he or she was first eligible for coverage under this agreement; The person waived coverage under this agreement due to being covered on another plan; and The coverage on the other plan is terminated as a result of: loss of eligibility for the coverage (including as a result of legal separation, divorce, death, termination of employment, or a reduction in the number of hours of employment), employer contributions towards such coverage being terminated, or COBRA, due to continuation, is exhausted. With a change in eligibility for Medicaid or a Children’s Health Insurance Program (CHIP), you must make written application within sixty (60) days following your change in eligibility. Coverage will begin on either the first day of the month following the event or, if the event occurs on the first day of a month, coverage under this agreement begins on the first day of that month. You and/or your eligible dependents will qualify for a Special Enrollment Period as follows: you and/or your eligible dependent are terminated from Medicaid or CHIP coverage due to a loss of eligibility; or you and/or your eligible dependent become eligible for premium assistance, under your employer’s coverage, through Medicaid or CHIP. In addition, you may also be eligible for the following Special Enrollment Periods if you apply within thirty (30) days following the Special Enrollment event: if you or your dependent lose minimum essential coverage, coverage begins the first day of the following month. Coverage for Members who are Hospitalized on their Effective Date If you are in the hospital on your effective date of coverage, health care services related to such hospitalization are covered as long as: (a) you notify us of your hospitalization within forty-eight (48) hours of the effective date, or as soon as is reasonably possible; and (b) covered health care services are received in accordance with the terms, conditions, exclusions and limitations of this agreement. As always, benefits paid in such situations are subject to the Coordination of benefits provisions described in Section 6.0.
Appears in 5 contracts
Samples: Subscriber Agreement, Subscriber Agreement, Subscriber Agreement
Open Enrollment. An Open Enrollment Period will be held each year for coverage to be effective on the first day of the plan year. You and/or your eligible dependents may enroll at this time by making written application during the open enrollment period. Special Enrollment Period After your initial effective date, you may enroll your eligible dependents for coverage through a Special Enrollment Period after you experience a change in family status, a loss of private health coverage, or a change in eligibility for Medicaid or a State Children’s Health Insurance Program (CHIP) as described below. With a change in family status, you must make written application within the thirty (30) days following the event. You and/or your eligible dependents will qualify for a Special Enrollment Period as follows: • if you get married, coverage begins the first day of the month following your marriage; • if you have a child born to the family, coverage begins on the date of the child’s birth; • if you have a child placed for adoption with your family, coverage begins on the date the child is placed for adoption with your family. In addition, if you lose your private health coverage, you must make written application within the thirty (30) days following the event. Coverage begins the first day of the month following the loss of private health coverage. If you or your eligible dependents have a loss of coverage on the first day of the month, coverage under this agreement begins on the first day of that month. You or your eligible dependents will qualify for a Special Enrollment Period if each of the following conditions is met: • The eligible person seeking coverage had other coverage at the time that he or she was first eligible for coverage under this agreement; • The person waived coverage under this agreement due to being covered on another plan; and • The coverage on the other plan is terminated as a result of: • loss of eligibility for the coverage (including as a result of legal separation, divorce, death, termination of employment, or a reduction in the number of hours of employment), • employer contributions towards such coverage being terminated, or • COBRA, due to continuation, is exhausted. With a change in eligibility for Medicaid or a Children’s Health Insurance Program (CHIP), you must make written application within sixty (60) days following your change in eligibility. Coverage will begin on either the first day of the month following the event or, if the event occurs on the first day of a month, coverage under this agreement begins on the first day of that month. You and/or your eligible dependents will qualify for a Special Enrollment Period as follows: • you and/or your eligible dependent are terminated from Medicaid or CHIP coverage due to a loss of eligibility; or • you and/or your eligible dependent become eligible for premium assistance, under your employer’s coverage, through Medicaid or CHIP. In addition, you may also be eligible for the following Special Enrollment Periods Period if you apply within thirty (30) days following the Special Enrollment event: • if you or your dependent lose minimum essential coverage, coverage begins the first day of the following month. Coverage for Members who are Hospitalized on their Effective Date If you are in the hospital on your effective date of coverage, health care services related to such hospitalization are covered as long as: (a) you notify us of your hospitalization within forty-eight (48) hours of the effective date, or as soon as is reasonably possible; and (b) covered health care services are received in accordance with the terms, conditions, exclusions and limitations of this agreement. As always, benefits paid in such situations are subject to the Coordination of benefits provisions described in Section 6.0.
Appears in 3 contracts
Samples: Subscriber Agreement, Subscriber Agreement, Subscriber Agreement
Open Enrollment. An Open Enrollment Period will be held each year for coverage to be effective on the first day of the plan year. You and/or your eligible dependents may enroll at this time by making written application during the open enrollment period. Special Enrollment Period After your initial effective date, you may enroll your eligible dependents for coverage through a Special Enrollment Period after you experience a change in family status, a loss of private health coverage, or a change in eligibility for Medicaid or a State Children’s Health Insurance Program (CHIP) as described below. With a change in family status, you must make written application within the thirty (30) days following the event. You and/or your eligible dependents will qualify for a Special Enrollment Period as follows: if you get married, coverage begins the first day of the month following your marriage; if you have a child born to the family, coverage begins on the date of the child’s birth; if you have a child placed for adoption with your family, coverage begins on the date the child is placed for adoption with your family. In addition, if you lose your private health coverage, you must make written application within the thirty (30) days following the event. Coverage begins the first day of the month following the loss of private health coverage. If you or your eligible dependents have a loss of coverage on the first day of the month, coverage under this agreement begins on the first day of that month. You or your eligible dependents will qualify for a Special Enrollment Period if each of the following conditions is met: The eligible person seeking coverage had other coverage at the time that he or she was first eligible for coverage under this agreement; The person waived coverage under this agreement due to being covered on another plan; and The coverage on the other plan is terminated as a result of: loss of eligibility for the coverage (including as a result of legal separation, divorce, death, termination of employment, or a reduction in the number of hours of employment), employer contributions towards such coverage being terminated, or COBRA, due to continuation, is exhausted. With a change in eligibility for Medicaid or a Children’s Health Insurance Program (CHIP), you must make written application within sixty (60) days following your change in eligibility. Coverage will begin on either the first day of the month following the event or, if the event occurs on the first day of a month, coverage under this agreement begins on the first day of that month. You and/or your eligible dependents will qualify for a Special Enrollment Period as follows: you and/or your eligible dependent are terminated from Medicaid or CHIP coverage due to a loss of eligibility; or you and/or your eligible dependent become eligible for premium assistance, under your employer’s coverage, through Medicaid or CHIP. In addition, you may also be eligible for the following Special Enrollment Periods Period if you apply within thirty (30) days following the Special Enrollment event: if you or your dependent lose minimum essential coverage, coverage begins the first day of the following month. Coverage for Members who are Hospitalized on their Effective Date If you are in the hospital on your effective date of coverage, health care services related to such hospitalization are covered as long as: (a) you notify us of your hospitalization within forty-eight (48) hours of the effective date, or as soon as is reasonably possible; and (b) covered health care services are received in accordance with the terms, conditions, exclusions and limitations of this agreement. As always, benefits paid in such situations are subject to the Coordination of benefits provisions described in Section 6.0.
Appears in 3 contracts
Samples: Subscriber Agreement, Subscriber Agreement, Subscriber Agreement
Open Enrollment. An Open Enrollment Period will be held each year for coverage to be effective on the first day of the plan year. You and/or your eligible dependents may enroll at this time by making written application during the open enrollment period. Special Enrollment Period After your initial effective date, you may enroll your eligible dependents for coverage through a Special Enrollment Period after you experience a change in family status, a loss of private health coverage, or a change in eligibility for Medicaid or a State Children’s Health Insurance Program (CHIP) as described below. With a change in family status, you must make written application within the thirty (30) days following the event. You and/or your eligible dependents will qualify for a Special Enrollment Period as follows: • if you get married, coverage begins the first day of the month following your marriage; • if you have a child born to the family, coverage begins on the date of the child’s birth; • if you have a child placed for adoption with your family, coverage begins on the date the child is placed for adoption with your family. In addition, if you lose your private health coverage, you must make written application within the thirty (30) days following the event. Coverage begins the first day of the month following the loss of private health coverage. If you or your eligible dependents have a loss of coverage on the first day of the month, coverage under this agreement begins on the first day of that month. You or your eligible dependents will qualify for a Special Enrollment Period if each of the following conditions is met: • The eligible person seeking coverage had other coverage at the time that he or she was first eligible for coverage under this agreement; • The person waived coverage under this agreement due to being covered on another plan; and • The coverage on the other plan is terminated as a result of: • loss of eligibility for the coverage (including as a result of legal separation, divorce, death, termination of employment, or a reduction in the number of hours of employment), • employer contributions towards such coverage being terminated, or • COBRA, due to continuation, is exhausted. With a change in eligibility for Medicaid or a Children’s Health Insurance Program (CHIP), you must make written application within sixty (60) days following your change in eligibility. Coverage will begin on either the first day of the month following the event or, if the event occurs on the first day of a month, coverage under this agreement begins on the first day of that month. You and/or your eligible dependents will qualify for a Special Enrollment Period as follows: • you and/or your eligible dependent are terminated from Medicaid or CHIP coverage due to a loss of eligibility; or • you and/or your eligible dependent become eligible for premium assistance, under your employer’s coverage, through Medicaid or CHIP. In addition, you may also be eligible for the following Special Enrollment Periods if you apply within thirty (30) days following the Special Enrollment event: • if you or your dependent lose minimum essential coverage, coverage begins the first day of the following month. Coverage for Members who are Hospitalized on their Effective Date If you are in the hospital on your effective date of coverage, health care services related to such hospitalization are covered as long as: (a) you notify us of your hospitalization within forty-eight (48) hours of the effective date, or as soon as is reasonably possible; and (b) covered health care services are received in accordance with the terms, conditions, exclusions and limitations of this agreement. As always, benefits paid in such situations are subject to the Coordination of benefits provisions described in Section 6.0.
Appears in 3 contracts
Samples: Subscriber Agreement, Subscriber Agreement, Subscriber Agreement
Open Enrollment. An Open Enrollment Period will be held each year for coverage to be effective on the first day of the plan year. You and/or your eligible dependents may enroll at this time by making written application during the open enrollment period. Special Enrollment Period After your initial effective date, you may enroll your eligible dependents for coverage through a Special Enrollment Period after you experience a change in family status, a loss of private health coverage, or a change in eligibility for Medicaid or a State Children’s Health Insurance Program (CHIP) as described below. With a change in family status, you must make written application within the thirty (30) days following the event. You and/or your eligible dependents will qualify for a Special Enrollment Period as follows: • if you get married, coverage begins the first day of the month following your marriage; • if you have a child born to the family, coverage begins on the date of the child’s birth; • if you have a child placed for adoption with your family, coverage begins on the date the child is placed for adoption with your family. In addition, if you lose your private health coverage, you must make written application within the thirty (30) days following the event. Coverage begins the first day of the month following the loss of private health coverage. If you or your eligible dependents have a loss of coverage on the first day of the month, coverage under this agreement begins on the first day of that month. You or your eligible dependents will qualify for a Special Enrollment Period if each of the following conditions is met: • The eligible person seeking coverage had other coverage at the time that he or she was first eligible for coverage under this agreement; • The person waived coverage under this agreement due to being covered on another plan; and • The coverage on the other plan is terminated as a result of: • loss of eligibility for the coverage (including as a result of legal separation, divorce, death, termination of employment, or a reduction in the number of hours of employment), • employer contributions towards such coverage being terminated, or • COBRA, due to continuation, is exhausted. With a change in eligibility for Medicaid or a Children’s Health Insurance Program (CHIP), you must make written application within sixty (60) days following your change in eligibility. Coverage will begin on either the first day of the month following the event or, if the event occurs on the first day of a month, coverage under this agreement begins on the first day of that month. You and/or your eligible dependents will qualify for a Special Enrollment Period as follows: • you and/or your eligible dependent are terminated from Medicaid or CHIP coverage due to a loss of eligibility; or • you and/or your eligible dependent become eligible for premium assistance, under your employer’s coverage, through Medicaid or CHIP. In addition, you may also be eligible for the following Special Enrollment Periods if you apply within thirty (30) days following the Special Enrollment event: • if you or your dependent lose minimum essential coverage, coverage begins the first day of the following month. Coverage for Members who are Hospitalized on their Effective Date If you are in the hospital on your effective date of coverage, health care services related to such hospitalization are covered as long as: (a) you notify us of your hospitalization within forty-eight (48) hours of the effective date, or as soon as is reasonably possible; and (b) covered health care services are received in accordance with the terms, conditions, exclusions and limitations of this agreement. As always, benefits paid in such situations are subject to the Coordination of benefits provisions described in Section 6.0.eight
Appears in 2 contracts
Samples: Subscriber Agreement, Subscriber Agreement
Open Enrollment. An Open Enrollment Period will be held each year for coverage to be effective on the first day of the plan year. You and/or your eligible dependents may enroll at this time by making written application during the open enrollment period. Special Enrollment Period After your initial effective date, you may enroll your eligible dependents for coverage through a Special Enrollment Period after you experience a change in family status, a loss of private health coverage, or a change in eligibility for Medicaid or a State Children’s Health Insurance Program (CHIP) as described below. With a change in family status, you must make written application within the thirty (30) days following the event. You and/or your eligible dependents will qualify for a Special Enrollment Period as follows: if you get married, coverage begins the first day of the month following your marriage; if you have a child born to the family, coverage begins on the date of the child’s birth; if you have a child placed for adoption with your family, coverage begins on the date the child is placed for adoption with your family. In addition, if you lose your With a loss of private health coverage, you must make written application within the thirty (30) days following the event. Coverage begins the first day of the month following the loss of private health coverage. If you or your eligible dependents have a loss of coverage on the first day of the month, coverage under this agreement begins on the first day of that month. You or your eligible dependents will qualify for a Special Enrollment Period if each of the following conditions is met: The eligible person seeking coverage had other coverage at the time that he or she was first eligible for coverage under this agreement; The person waived coverage under this agreement due to being covered on another plan; and The coverage on the other plan is terminated as a result of: loss of eligibility for the coverage (including as a result of legal separation, divorce, death, termination of employment, or a reduction in the number of hours of employment), employer contributions towards such coverage being terminated, or COBRA, due to continuation, is exhausted. With a change in eligibility for Medicaid or a Children’s Health Insurance Program (CHIP), you must make written application within sixty (60) days following your change in eligibility. Coverage will begin on either the first day of the month following the event or, if the event occurs on the first day of a month, coverage under this agreement begins on the first day of that month. You and/or your eligible dependents will qualify for a Special Enrollment Period as follows: you and/or your eligible dependent are terminated from Medicaid or CHIP coverage due to a loss of eligibility; or you and/or your eligible dependent become eligible for premium assistance, under your employer/agent’s coverage, through Medicaid or CHIP. In addition, you may also be eligible for the following Special Enrollment Periods if you apply within thirty (30) days following the Special Enrollment event: if you or your dependent lose minimum essential coverage, coverage begins the first day of the following month. Coverage for Members who are Hospitalized on their Effective Date If you are in the hospital on your effective date of coverage, health care services related to such hospitalization are covered as long as: (a) you notify us of your hospitalization within forty-eight (48) hours of the effective date, or as soon as is reasonably possible; and (b) covered health care services are received in accordance with the terms, conditions, exclusions and limitations of this agreement. As always, benefits paid in such situations are subject to the Coordination of benefits provisions described in Section 6.0.
Appears in 2 contracts
Samples: Subscriber Agreement, Subscriber Agreement
Open Enrollment. An Open Enrollment Period will be held each year for coverage to be effective on the first day of the plan year. You and/or your eligible dependents may enroll at this time by making written application during the open enrollment period. Special Enrollment Period After your initial effective date, you may enroll your eligible dependents for coverage through a Special Enrollment Period after you experience a change in family status, a loss of private health coverage, or a change in eligibility for Medicaid or a State Children’s Health Insurance Program (CHIP) as described below. With a change in family status, you must make written application within the thirty (30) days following the event. You and/or your eligible dependents will qualify for a Special Enrollment Period as follows: if you get married, coverage begins the first day of the month following your marriage; if you have a child born to the family, coverage begins on the date of the child’s birth; if you have a child placed for adoption with your family, coverage begins on the date the child is placed for adoption with your family. In addition, if you lose your private health coverage, you must make written application within the thirty (30) days following the event. Coverage begins the first day of the month following the loss of private health coverage. If you or your eligible dependents have a loss of coverage on the first day of the month, coverage under this agreement begins on the first day of that month. You or your eligible dependents will qualify for a Special Enrollment Period if each of the following conditions is met: The eligible person seeking coverage had other coverage at the time that he or she was first eligible for coverage under this agreement; The person waived coverage under this agreement due to being covered on another plan; and The coverage on the other plan is terminated as a result of: loss of eligibility for the coverage (including as a result of legal separation, divorce, death, termination of employment, or a reduction in the number of hours of employment), employer contributions towards such coverage being terminated, or COBRA, due to continuation, is exhausted. With a change in eligibility for Medicaid or a Children’s Health Insurance Program (CHIP), you must make written application within sixty (60) days following your change in eligibility. Coverage will begin on either the first day of the month following the event or, if the event occurs on the first day of a month, coverage under this agreement begins on the first day of that month. You and/or your eligible dependents will qualify for a Special Enrollment Period as follows: you and/or your eligible dependent are terminated from Medicaid or CHIP coverage due to a loss of eligibility; or you and/or your eligible dependent become eligible for premium assistance, under your employer’s coverage, through Medicaid or CHIP. In addition, you may also be eligible for the following Special Enrollment Periods if you apply within thirty (30) days following the Special Enrollment event: if you or your dependent lose minimum essential coverage, coverage begins the first day of the following month. Coverage for Members who are Hospitalized on their Effective Date If you are in the hospital on your effective date of coverage, health care services related to such hospitalization are covered as long as: (a) you notify us of your hospitalization within forty-eight (48) hours of the effective date, or as soon as is reasonably possible; and (b) covered health care services are received in accordance with the terms, conditions, exclusions and limitations of this agreement. As always, benefits paid in such situations are subject to the Coordination of benefits provisions described in Section 6.0.eight
Appears in 2 contracts
Samples: Subscriber Agreement, Subscriber Agreement
Open Enrollment. An Open Enrollment Period will be held each year for coverage to be effective on the first day of the plan year. You and/or your eligible dependents may enroll at this time by making written application during the open enrollment period. Special Enrollment Period After your initial effective date, you may enroll your eligible dependents for coverage through a Special Enrollment Period after you experience a change in family status, a loss of private health coverage, or a change in eligibility for Medicaid or a State Children’s Health Insurance Program (CHIP) as described below. With a change in family status, you must make written application within the thirty (30) days following the event. You and/or your eligible dependents will qualify for a Special Enrollment Period as follows: if you get married, coverage begins the first day of the month following your marriage; if you have a child born to the family, coverage begins on the date of the child’s birth; if you have a child placed for adoption with your family, coverage begins on the date the child is placed for adoption with your family. In addition, if you lose your With a loss of private health coverage, you must make written application within the thirty (30) days following the event. Coverage begins the first day of the month following the loss of private health coverage. If you or your eligible dependents have a loss of coverage on the first day of the month, coverage under this agreement begins on the first day of that month. You or your eligible dependents will qualify for a Special Enrollment Period if each of the following conditions is met: The eligible person seeking coverage had other coverage at the time that he or she was first eligible for coverage under this agreement; The person waived coverage under this agreement due to being covered on another plan; and The coverage on the other plan is terminated as a result of: loss of eligibility for the coverage (including as a result of legal separation, divorce, death, termination of employment, or a reduction in the number of hours of employment), employer contributions towards such coverage being terminated, or COBRA, due to continuation, is exhausted. With a change in eligibility for Medicaid or a Children’s Health Insurance Program (CHIP), you must make written application within sixty (60) days following your change in eligibility. Coverage will begin on either the first day of the month following the event or, if the event occurs on the first day of a month, coverage under this agreement begins on the first day of that month. You and/or your eligible dependents will qualify for a Special Enrollment Period as follows: you and/or your eligible dependent are terminated from Medicaid or CHIP coverage due to a loss of eligibility; or you and/or your eligible dependent become eligible for premium assistance, under your employer/agent’s coverage, through Medicaid or CHIP. In addition, you may also be eligible for the following Special Enrollment Periods Period if you apply within thirty (30) days following the Special Enrollment event: if you or your dependent lose minimum essential coverage, coverage begins the first day of the following month. Coverage for Members who are Hospitalized on their Effective Date If you are in the hospital on your effective date of coverage, health care services related to such hospitalization are covered as long as: (a) you notify us of your hospitalization within forty-eight (48) hours of the effective date, or as soon as is reasonably possible; and (b) covered health care services are received in accordance with the terms, conditions, exclusions and limitations of this agreement. As always, benefits paid in such situations are subject to the Coordination of benefits provisions described in Section 6.0.
Appears in 1 contract
Samples: Subscriber Agreement
Open Enrollment. An Open Enrollment Period The open enrollment period will be held each year for coverage to be effective on defined by the first day of federal government. This enrollment period applies whether purchasing through the plan year. You and/or your eligible dependents may enroll at this time by making written application during the open enrollment period. Special Enrollment Period After your initial effective date, you may enroll your eligible dependents for coverage through a Special Enrollment Period after you experience a change in family status, a loss of private health coverage, or a change in eligibility for Medicaid or a State Children’s Health Insurance Program Marketplace or directly from Alliant Health Plans. Qualifying Life Event SEP Window Effective date (CHIPsubject to review) as described below. With a change in family statusAdditional Information Birth Adoption Placement for Adoption May apply 60 days before or after event, you must make written application within the thirty (30) days following but effective date cannot be prior to the event. You and/or your eligible dependents will qualify for a Special Enrollment Period as follows: if you get marriedFor adoption, coverage begins date of The effective date may be either the first day DOB or the 1st of the month following your marriagebirth; except in cases of adoption where it is the date upon legal assumption. (If the child if you have a child born Although application can be made prior to the familyevent, the event itself must actually occur and coverage begins on cannot begin prior to the date event. Pregnancy is NOT a QLE, and will not be eligible until after the birth of the child’s birth. However, pregnancy may make an individual eligible for Medicaid. placement is defined as is auto enrolled in a parents when adopting parents plan, the parents plan pays assume legal/financial primary and ours responsibility. secondary; even if the parents plan is with Alliant). Marriage May apply 60 days before or after the marriage date. 1st of the following month from a complete application submission if rec’d by the 15th and 1st of the 2nd month if rec’d after the 15th. if you have a child placed All family members are eligible for adoption with your familythe SEP Although application can be made prior to the event, the event itself must take place and coverage begins on the date the child is placed for adoption with your family. In addition, if you lose your private health coverage, you must make written application within the thirty (30) days following cannot begin prior to the event. Coverage begins the first day of the month following the Qualifying Life Event SEP Window Effective date (subject to review) Additional Information Involuntary loss of private Minimum Essential Coverage (MEC) and/or Loss of employer sponsored health coverage. If you or your eligible dependents have a loss of coverage on the first day of the monthinsurance, coverage under this agreement begins on the first day of that month. You or your eligible dependents will qualify for a Special Enrollment Period if each of the following conditions is met: The eligible person seeking coverage had other coverage at the time that he or she was first eligible for coverage under this agreement; The person waived coverage under this agreement due to being covered on another plan; and The coverage on the other plan is terminated as a result of: loss Termination of eligibility for employment May apply 60 days before event or up to 60 days after event. The “event” is the date that the coverage is lost. 1st of the following month from a complete application submission if rec’d by the 15th and 1st of 2nd month if rec’d after the 15th. An SEP is not available in the following circumstances: Voluntarily quitting other health coverage or being terminated for not paying premiums Losing coverage that is not considered minimum essential coverage (including as a result of legal separation, divorce, death, example: Limited Benefit Plan). See separate event for termination of employmentShort-Term- Medical coverage. (See STM below) Although application can be made prior to the event, or the event itself must take place and coverage cannot begin prior to the event. If offered COBRA coverage, individual is not required to take the COBRA coverage. Also see Exhaustion of COBRA Employer reduces work hours to the point where no longer covered by the health plan Employer’s plan decides it will no longer offer coverage to a reduction in the number certain group of hours individuals for example, those who work part time) Termination of employment), employer contributions towards such coverage being terminated, or COBRA, due to continuation, is exhausted. With a change in Loss of eligibility for Medicaid or a Children’s Health Insurance Program (CHIP)CHIP May apply 60 days before or after event, you must make written application within sixty (60) days following your change in eligibilitybut effective date cannot be prior to the event. Coverage will begin on either the first day 1st of the following month following from a complete application submission if rec’d by the event or, 15th and 1st of 2nd month if rec’d after the event occurs on the first day of a month, coverage under this agreement begins on the first day of that month15th. You and/or your eligible dependents will qualify for a Special Enrollment Period as follows: you and/or your eligible dependent are terminated from Individual must actually have been enrolled in Medicaid or CHIP plan, and are losing coverage. Although application can be made prior to the event, the event itself must take place and coverage cannot begin prior to the event. The event is the last day of coverage. Qualifying Life Event SEP Window Effective date (subject to review) Additional Information Divorce/Leg al Separation Qualified Medical Support Order (QMSO) May apply 60 days before or after event, but effective date cannot be prior to the event. Divorce: The event is the court ordered date of dissolution. 1st of the following month from a complete application submission if rec’d by the 15th and 1st of 2nd month if rec’d after the 15th. A court order to provide health insurance for a child is not, by itself, a QLE. There must be an underlying event like loss of coverage to make the child eligible for an SEP. Although application can be made prior to the event, the event itself must take place and coverage cannot begin prior to the event. Loss of retiree May apply 60 days before or after event, but effective date cannot be prior to the event. The event is the last day of coverage. 1st of the following month from a complete application submission if rec’d by the 15th and 1st of 2nd month if rec’d after the 15th. Although application can be made prior to the event, the event itself must take place and coverage cannot begin prior to the event. coverage due to former employer filing for bankruptcy protection Death of the policyholder May apply 60 days before loss of coverage or up to 60 days after loss of coverage. 1st of the following month from a complete application submission if rec’d by the 15th and 1st of 2nd month if rec’d after the 15th. Although application can be made prior to the event, the event itself must take place and coverage cannot begin prior to the event. The event date is the loss of actual coverage. Gaining status as a citizen, national or lawfully present individual 60 days after event 1st of the following month from a complete application submission if rec’d by the 15th and 1st of 2nd month if rec’d after the 15th. Discharge from active military duty 60 days after event 1st of the following month from a complete application submission if rec’d by the 15th and 1st of 2nd month if rec’d after the 15th. Qualifying Life Event SEP Window Effective date (subject to review) Additional Information Loss of coverage due to a loss permanent move outside of eligibility; the plan’s service area May apply 60 days before event or you and/or your eligible dependent become eligible for premium assistance, under your employer’s coverage, through Medicaid or CHIPup to 60 days after event. In addition, you may also be eligible for the following Special Enrollment Periods if you apply within thirty (30) days following the Special Enrollment event: if you or your dependent lose minimum essential coverage, coverage begins the first day 1st of the following monthmonth from a complete application submission if rec’d by the 15th and 1st of 2nd month if rec’d after the 15th. Coverage for Members who are Hospitalized on their Effective Date Individual must have lost coverage due to the move. If you are no coverage in place, a move is not a QLE. New address must have a different ZIP code to be considered eligible Individual is eligible even if current coverage is not being cancelled due to the hospital on your effective date of move, or if never had coverage. Although application can be made prior to the event, health care services related the event itself must take place and coverage cannot begin prior to such hospitalization are covered as long as: (a) you notify us of your hospitalization within forty-eight (48) hours the event. Move to a new service area May apply 60 days before event or up to 60 days after event. 1st of the effective date, or as soon as is reasonably possible; following month from a complete application submission if rec’d by the 15th and (b) covered health care services are received in accordance with 1st of 2nd month if rec’d after the terms, conditions, exclusions and limitations of this agreement15th. As always, benefits paid in such situations are subject Although application can be made prior to the Coordination event, the event itself must take place and coverage cannot begin prior to the event. Loss of benefits provisions described in Section 6.0.coverage does not include voluntary termination of coverage or other loss due to—
Appears in 1 contract
Samples: www.alliantplans.com
Open Enrollment. An Open Enrollment Period The open enrollment period will be held each year for coverage to be effective on defined by the first day of federal government. This enrollment period applies whether purchasing through the plan year. You and/or your eligible dependents may enroll at this time by making written application during the open enrollment period. Special Enrollment Period After your initial effective date, you may enroll your eligible dependents for coverage through a Special Enrollment Period after you experience a change in family status, a loss of private health coverage, or a change in eligibility for Medicaid or a State Children’s Health Insurance Program Marketplace or directly from Alliant Health Plans. Qualifying Life Event SEP Window Effective date (CHIPsubject to review) as described below. With a change in family statusAdditional Information • Birth • Adoption • Placement for Adoption May apply 60 days before or after event, you must make written application within the thirty (30) days following but effective date cannot be prior to the event. You and/or your eligible dependents will qualify for a Special Enrollment Period For adoption, date of placement is defined as follows: if you get married, coverage begins when adopting parents assume legal/financial responsibility. The effective date may be either the first day DOB or the 1st of the month following your marriagebirth; except in cases of adoption where it is the date upon legal assumption. (If the child is auto enrolled in a parents plan, the parents plan pays primary and ours secondary; even if you have a child born the parents plan is with Alliant). • Although application can be made prior to the familyevent, the event itself must actually occur and coverage begins on cannot begin prior to the date event. • Pregnancy is NOT a QLE, and will not be eligible until after the birth of the child’s birth; . However, pregnancy may make an individual eligible for Medicaid. Marriage May apply 60 days before or after the marriage date. 1st of the following month from a complete application submission if you have a child placed rec’d by the 15th and 1st of the 2nd month if rec’d after the 15th. • All family members are eligible for adoption with your familythe SEP • Although application can be made prior to the event, the event itself must take place and coverage begins on the date the child is placed for adoption with your family. In addition, if you lose your private health coverage, you must make written application within the thirty (30) days following cannot begin prior to the event. Coverage begins the first day of the month following the Qualifying Life Event SEP Window Effective date (subject to review) Additional Information Involuntary loss of private Minimum Essential Coverage (MEC) and/or Loss of employer sponsored health coverage. If you or your eligible dependents have a loss of coverage on the first day of the monthinsurance, coverage under this agreement begins on the first day of that month. You or your eligible dependents will qualify for a Special Enrollment Period if each of the following conditions is met: The eligible person seeking coverage had other coverage at the time that he or she was first eligible for coverage under this agreement; The person waived coverage under this agreement due to being covered on another plan; and The coverage on the other plan is terminated as a result of: loss • Termination of eligibility employment • Employer reduces work hours to the point where no longer covered by the health plan • Employer’s plan decides it will no longer offer coverage to a certain group of individuals for example, those who work part time) • Termination of employer contributions May apply 60 days before event or up to 60 days after event. The “event” is the date that the coverage is lost. 1st of the following month from a complete application submission if rec’d by the 15th and 1st of 2nd month if rec’d after the 15th. An SEP is not available in the following circumstances: • Voluntarily quitting other health coverage or being terminated for not paying premiums • Losing coverage that is not considered minimum essential coverage (including as a result of legal separation, divorce, death, example: Limited Benefit Plan). See separate event for termination of employmentShort-Term- Medical coverage. (See STM below) • Although application can be made prior to the event, or a reduction in the number event itself must take place and coverage cannot begin prior to the event. If offered COBRA coverage, individual is not required to take the COBRA coverage. Also see Exhaustion of hours COBRA Loss of employment), employer contributions towards such coverage being terminated, or COBRA, due to continuation, is exhausted. With a change in eligibility for Medicaid or a Children’s Health Insurance Program (CHIP)CHIP May apply 60 days before or after event, you must make written application within sixty (60) days following your change in eligibilitybut effective date cannot be prior to the event. Coverage will begin on either The event is the first last day of coverage. 1st of the following month following from a complete application submission if rec’d by the event or, 15th and 1st of 2nd month if rec’d after the event occurs on the first day of a month, coverage under this agreement begins on the first day of that month15th. You and/or your eligible dependents will qualify for a Special Enrollment Period as follows: you and/or your eligible dependent are terminated from • Individual must actually have been enrolled in Medicaid or CHIP plan, and are losing coverage. • Although application can be made prior to the event, the event itself must take place and coverage cannot begin prior to the event. Qualifying Life Event SEP Window Effective date (subject to review) Additional Information • Divorce/Leg al Separation • Qualified Medical Support Order (QMSO) May apply 60 days before or after event, but effective date cannot be prior to the event. Divorce: The event is the court ordered date of dissolution. 1st of the following month from a complete application submission if rec’d by the 15th and 1st of 2nd month if rec’d after the 15th. • A court order to provide health insurance for a child is not, by itself, a QLE. There must be an underlying event like loss of coverage to make the child eligible for an SEP. • Although application can be made prior to the event, the event itself must take place and coverage cannot begin prior to the event. Loss of retiree coverage due to former employer filing for bankruptcy protection May apply 60 days before or after event, but effective date cannot be prior to the event. The event is the last day of coverage. 1st of the following month from a complete application submission if rec’d by the 15th and 1st of 2nd month if rec’d after the 15th. Although application can be made prior to the event, the event itself must take place and coverage cannot begin prior to the event. Death of the policyholder May apply 60 days before loss of coverage or up to 60 days after loss of coverage. The event date is the loss of actual coverage. 1st of the following month from a complete application submission if rec’d by the 15th and 1st of 2nd month if rec’d after the 15th. Although application can be made prior to the event, the event itself must take place and coverage cannot begin prior to the event. Gaining status as a citizen, national or lawfully present individual 60 days after event 1st of the following month from a complete application submission if rec’d by the 15th and 1st of 2nd month if rec’d after the 15th. Discharge from active military duty 60 days after event 1st of the following month from a complete application submission if rec’d by the 15th and 1st of 2nd month if rec’d after the 15th. Qualifying Life Event SEP Window Effective date (subject to review) Additional Information Loss of coverage due to a loss permanent move outside of eligibility; the plan’s service area May apply 60 days before event or you and/or your eligible dependent become eligible for premium assistance, under your employer’s coverage, through Medicaid or CHIPup to 60 days after event. In addition, you may also be eligible for the following Special Enrollment Periods if you apply within thirty (30) days following the Special Enrollment event: if you or your dependent lose minimum essential coverage, coverage begins the first day 1st of the following monthmonth from a complete application submission if rec’d by the 15th and 1st of 2nd month if rec’d after the 15th. Coverage for Members who are Hospitalized on their Effective Date • Individual must have lost coverage due to the move. If you are no coverage in place, a move is not a QLE. • New address must have a different ZIP code to be considered eligible • Individual is eligible even if current coverage is not being cancelled due to the hospital on your effective date of move, or if never had coverage. • Although application can be made prior to the event, health care services related the event itself must take place and coverage cannot begin prior to such hospitalization are covered as long as: (a) you notify us of your hospitalization within forty-eight (48) hours the event. Move to a new service area May apply 60 days before event or up to 60 days after event. 1st of the effective date, or as soon as is reasonably possible; following month from a complete application submission if rec’d by the 15th and (b) covered health care services are received in accordance with 1st of 2nd month if rec’d after the terms, conditions, exclusions and limitations of this agreement15th. As always, benefits paid in such situations are subject • Although application can be made prior to the Coordination event, the event itself must take place and coverage cannot begin prior to the event. Loss of benefits provisions described in Section 6.0.coverage does not include voluntary termination of coverage or other loss due to—
Appears in 1 contract
Samples: alliantplans.com
Open Enrollment. An Open Enrollment Period will be held each year for coverage to be effective on the first day of the plan year. You and/or your eligible dependents may enroll at this time by making written application during the open enrollment period. Special Enrollment Period After your initial effective date, you may enroll your eligible dependents for coverage through a Special Enrollment Period after you experience a change in family status, a loss of private health coverage, or a change in eligibility for Medicaid or a State Children’s Health Insurance Program (CHIP) as described below. With a change in family status, you must make written application within the thirty (30) days following the event. You and/or your eligible dependents will qualify for a Special Enrollment Period as follows: • if you get married, coverage begins the first day of the month following your marriage; • if you have a child born to the family, coverage begins on the date of the child’s birth; • if you have a child placed for adoption with your family, coverage begins on the date the child is placed for adoption with your family. In addition, if you lose your With a loss of private health coverage, you must make written application within the thirty (30) days following the event. Coverage begins the first day of the month following the loss of private health coverage. If you or your eligible dependents have a loss of coverage on the first day of the month, coverage under this agreement begins on the first day of that month. You or your eligible dependents will qualify for a Special Enrollment Period if each of the following conditions is met: • The eligible person seeking coverage had other coverage at the time that he or she was first eligible for coverage under this agreement; • The person waived coverage under this agreement due to being covered on another plan; and • The coverage on the other plan is terminated as a result of: • loss of eligibility for the coverage (including as a result of legal separation, divorce, death, termination of employment, or a reduction in the number of hours of employment), • employer contributions towards such coverage being terminated, or • COBRA, due to continuation, is exhausted. With a change in eligibility for Medicaid or a Children’s Health Insurance Program (CHIP), you must make written application within sixty (60) days following your change in eligibility. Coverage will begin on either the first day of the month following the event or, if the event occurs on the first day of a month, coverage under this agreement begins on the first day of that month. You and/or your eligible dependents will qualify for a Special Enrollment Period as follows: • you and/or your eligible dependent are terminated from Medicaid or CHIP coverage due to a loss of eligibility; or • you and/or your eligible dependent become eligible for premium assistance, under your employer/agent’s coverage, through Medicaid or CHIP. In addition, you may also be eligible for the following Special Enrollment Periods if you apply within thirty (30) days following the Special Enrollment event: • if you or your dependent lose minimum essential coverage, coverage begins the first day of the following month. Coverage for Members who are Hospitalized on their Effective Date If you are in the hospital on your effective date of coverage, health care services related to such hospitalization are covered as long as: (a) you notify us of your hospitalization within forty-eight (48) hours of the effective date, or as soon as is reasonably possible; and (b) covered health care services are received in accordance with the terms, conditions, exclusions and limitations of this agreement. As always, benefits paid in such situations are subject to the Coordination of benefits provisions described in Section 6.0.
Appears in 1 contract
Samples: Subscriber Agreement
Open Enrollment. An Open Enrollment Period The open enrollment period will be held each year for coverage to be effective on defined by the first day of federal government. This enrollment period applies whether purchasing through the plan year. You and/or your eligible dependents may enroll at this time by making written application during the open enrollment period. Special Enrollment Period After your initial effective date, you may enroll your eligible dependents for coverage through a Special Enrollment Period after you experience a change in family status, a loss of private health coverage, or a change in eligibility for Medicaid or a State Children’s Health Insurance Program Marketplace or directly from Alliant Health Plans. Qualifying Life Event SEP Window Effective date (CHIPsubject to review) as described below. With a change in family statusAdditional Information Birth Adoption Placement for Adoption May apply 60 days before or after event, you must make written application within the thirty (30) days following but effective date cannot be prior to the event. You and/or your eligible dependents will qualify for a Special Enrollment Period For adoption, date of placement is defined as follows: if you get married, coverage begins when adopting parents assume legal/financial responsibility. The effective date may be either the first day DOB or the 1st of the month following your marriagebirth; except in cases of adoption where it is the date upon legal assumption. (If the child is auto enrolled in a parents plan, the parents plan pays primary and ours secondary; even if the parents plan is with Alliant). if you have a child born Although application can be made prior to the familyevent, the event itself must actually occur and coverage begins on cannot begin prior to the date event. Pregnancy is NOT a QLE, and will not be eligible until after the birth of the child’s birth; . However, pregnancy may make an individual eligible for Medicaid. Marriage May apply 60 days before or after the marriage date. 1st of the following month from a complete application submission if rec’d by the 15th and 1st of the 2nd month if rec’d after the 15th. if you have a child placed All family members are eligible for adoption with your familythe SEP Although application can be made prior to the event, the event itself must take place and coverage begins on the date the child is placed for adoption with your family. In addition, if you lose your private health coverage, you must make written application within the thirty (30) days following cannot begin prior to the event. Coverage begins the first day of the month following the Qualifying Life Event SEP Window Effective date (subject to review) Additional Information Involuntary loss of private Minimum Essential Coverage (MEC) and/or Loss of employer sponsored health coverage. If you or your eligible dependents have a loss of coverage on the first day of the monthinsurance, coverage under this agreement begins on the first day of that month. You or your eligible dependents will qualify for a Special Enrollment Period if each of the following conditions is met: The eligible person seeking coverage had other coverage at the time that he or she was first eligible for coverage under this agreement; The person waived coverage under this agreement due to being covered on another plan; and The coverage on the other plan is terminated as a result of: loss Termination of eligibility employment Employer reduces work hours to the point where no longer covered by the health plan Employer’s plan decides it will no longer offer coverage to a certain group of individuals for example, those who work part time) Termination of employer contributions May apply 60 days before event or up to 60 days after event. The “event” is the date that the coverage is lost. 1st of the following month from a complete application submission if rec’d by the 15th and 1st of 2nd month if rec’d after the 15th. An SEP is not available in the following circumstances: Voluntarily quitting other health coverage or being terminated for not paying premiums Losing coverage that is not considered minimum essential coverage (including as a result of legal separation, divorce, death, example: Limited Benefit Plan). See separate event for termination of employmentShort-Term- Medical coverage. (See STM below) Although application can be made prior to the event, or a reduction in the number event itself must take place and coverage cannot begin prior to the event. If offered COBRA coverage, individual is not required to take the COBRA coverage. Also see Exhaustion of hours COBRA Loss of employment), employer contributions towards such coverage being terminated, or COBRA, due to continuation, is exhausted. With a change in eligibility for Medicaid or a Children’s Health Insurance Program (CHIP)CHIP May apply 60 days before or after event, you must make written application within sixty (60) days following your change in eligibilitybut effective date cannot be prior to the event. Coverage will begin on either The event is the first last day of coverage. 1st of the following month following from a complete application submission if rec’d by the event or, 15th and 1st of 2nd month if rec’d after the event occurs on the first day of a month, coverage under this agreement begins on the first day of that month15th. You and/or your eligible dependents will qualify for a Special Enrollment Period as follows: you and/or your eligible dependent are terminated from Individual must actually have been enrolled in Medicaid or CHIP plan, and are losing coverage. Although application can be made prior to the event, the event itself must take place and coverage cannot begin prior to the event. Qualifying Life Event SEP Window Effective date (subject to review) Additional Information Divorce/Leg al Separation Qualified Medical Support Order (QMSO) May apply 60 days before or after event, but effective date cannot be prior to the event. Divorce: The event is the court ordered date of dissolution. 1st of the following month from a complete application submission if rec’d by the 15th and 1st of 2nd month if rec’d after the 15th. A court order to provide health insurance for a child is not, by itself, a QLE. There must be an underlying event like loss of coverage to make the child eligible for an SEP. Although application can be made prior to the event, the event itself must take place and coverage cannot begin prior to the event. Loss of retiree May apply 60 days before or after event, but effective date cannot be prior to the event. The event is the last day of coverage. 1st of the following month from a complete application submission if rec’d by the 15th and 1st of 2nd month if rec’d after the 15th. Although application can be made prior to the event, the event itself must take place and coverage cannot begin prior to the event. coverage due to former employer filing for bankruptcy protection Death of the policyholder May apply 60 days before loss of coverage or up to 60 days after loss of coverage. 1st of the following month from a complete application submission if rec’d by the 15th and 1st of 2nd month if rec’d after the 15th. Although application can be made prior to the event, the event itself must take place and coverage cannot begin prior to the event. The event date is the loss of actual coverage. Gaining status as a citizen, national or lawfully present individual 60 days after event 1st of the following month from a complete application submission if rec’d by the 15th and 1st of 2nd month if rec’d after the 15th. Discharge from active military duty 60 days after event 1st of the following month from a complete application submission if rec’d by the 15th and 1st of 2nd month if rec’d after the 15th. Qualifying Life Event SEP Window Effective date (subject to review) Additional Information Loss of coverage due to a loss permanent move outside of eligibility; the plan’s service area May apply 60 days before event or you and/or your eligible dependent become eligible for premium assistance, under your employer’s coverage, through Medicaid or CHIPup to 60 days after event. In addition, you may also be eligible for the following Special Enrollment Periods if you apply within thirty (30) days following the Special Enrollment event: if you or your dependent lose minimum essential coverage, coverage begins the first day 1st of the following monthmonth from a complete application submission if rec’d by the 15th and 1st of 2nd month if rec’d after the 15th. Coverage for Members who are Hospitalized on their Effective Date Individual must have lost coverage due to the move. If you are no coverage in place, a move is not a QLE. New address must have a different ZIP code to be considered eligible Individual is eligible even if current coverage is not being cancelled due to the hospital on your effective date of move, or if never had coverage. Although application can be made prior to the event, health care services related the event itself must take place and coverage cannot begin prior to such hospitalization are covered as long as: (a) you notify us of your hospitalization within forty-eight (48) hours the event. Move to a new service area May apply 60 days before event or up to 60 days after event. 1st of the effective date, or as soon as is reasonably possible; following month from a complete application submission if rec’d by the 15th and (b) covered health care services are received in accordance with 1st of 2nd month if rec’d after the terms, conditions, exclusions and limitations of this agreement15th. As always, benefits paid in such situations are subject Although application can be made prior to the Coordination event, the event itself must take place and coverage cannot begin prior to the event. Loss of benefits provisions described in Section 6.0.coverage does not include voluntary termination of coverage or other loss due to—
Appears in 1 contract
Samples: alliantplans.com
Open Enrollment. An Open Enrollment Period The open enrollment period will be held each year for coverage to be effective on defined by the first day of federal government. This enrollment period applies whether purchasing through the plan year. You and/or your eligible dependents may enroll at this time by making written application during the open enrollment period. Special Enrollment Period After your initial effective date, you may enroll your eligible dependents for coverage through a Special Enrollment Period after you experience a change in family status, a loss of private health coverage, or a change in eligibility for Medicaid or a State Children’s Health Insurance Program Marketplace or directly from Alliant Health Plans. Qualifying Life Event SEP Window Effective date (CHIPsubject to review) as described below. With a change in family statusAdditional Information • Birth • Adoption • Placement for Adoption May apply 60 days before or after event, you must make written application within the thirty (30) days following but effective date cannot be prior to the event. You and/or your eligible dependents will qualify for a Special Enrollment Period For adoption, date of placement is defined as follows: if you get married, coverage begins when adopting parents assume legal/financial responsibility. The effective date may be either the first day DOB or the 1st of the month following your marriagebirth; except in cases of adoption where it is the date upon legal assumption. (If the child is auto enrolled in a parents plan, the parents plan pays primary and ours secondary; even if you have a child born the parents plan is with Alliant). • Although application can be made prior to the familyevent, the event itself must actually occur and coverage begins on cannot begin prior to the date event. • Pregnancy is NOT a QLE, and will not be eligible until after the birth of the child’s birth; . However, pregnancy may make an individual eligible for Medicaid. Marriage May apply 60 days before or after the marriage date. 1st of the following month from a complete application submission if you have a child placed rec’d by the 15th and 1st of the 2nd month if rec’d after the 15th. • All family members are eligible for adoption with your familythe SEP • Although application can be made prior to the event, the event itself must take place and coverage begins on the date the child is placed for adoption with your family. In addition, if you lose your private health coverage, you must make written application within the thirty (30) days following cannot begin prior to the event. Coverage begins the first day of the month following the Qualifying Life Event SEP Window Effective date (subject to review) Additional Information Involuntary loss of private Minimum Essential Coverage (MEC) and/or Loss of employer sponsored health coverage. If you or your eligible dependents have a loss of coverage on the first day of the monthinsurance, coverage under this agreement begins on the first day of that month. You or your eligible dependents will qualify for a Special Enrollment Period if each of the following conditions is met: The eligible person seeking coverage had other coverage at the time that he or she was first eligible for coverage under this agreement; The person waived coverage under this agreement due to being covered on another plan; and The coverage on the other plan is terminated as a result of: loss • Termination of eligibility employment • Employer reduces work hours to the point where no longer covered by the health plan • Employer’s plan decides it will no longer offer coverage to a certain group of individuals for example, those who work part time) • Termination of employer contributions May apply 60 days before event or up to 60 days after event. The “event” is the date that the coverage is lost. 1st of the following month from a complete application submission if rec’d by the 15th and 1st of 2nd month if rec’d after the 15th. An SEP is not available in the following circumstances: • Voluntarily quitting other health coverage or being terminated for not paying premiums • Losing coverage that is not considered minimum essential coverage (including as a result of legal separation, divorce, death, example: Limited Benefit Plan). See separate event for termination of employmentShort-Term- Medical coverage. (See STM below) • Although application can be made prior to the event, or a reduction in the number event itself must take place and coverage cannot begin prior to the event. If offered COBRA coverage, individual is not required to take the COBRA coverage. Also see Exhaustion of hours COBRA Loss of employment), employer contributions towards such coverage being terminated, or COBRA, due to continuation, is exhausted. With a change in eligibility for Medicaid or a Children’s Health Insurance Program (CHIP)CHIP May apply 60 days before or after event, you must make written application within sixty (60) days following your change in eligibilitybut effective date cannot be prior to the event. Coverage will begin on either The event is the first last day of coverage. 1st of the following month following from a complete application submission if rec’d by the event or, 15th and 1st of 2nd month if rec’d after the event occurs on the first day of a month, coverage under this agreement begins on the first day of that month15th. You and/or your eligible dependents will qualify for a Special Enrollment Period as follows: you and/or your eligible dependent are terminated from • Individual must actually have been enrolled in Medicaid or CHIP plan, and are losing coverage. • Although application can be made prior to the event, the event itself must take place and coverage cannot begin prior to the event. Qualifying Life Event SEP Window Effective date (subject to review) Additional Information • Divorce/Leg al Separation • Qualified Medical Support Order (QMSO) May apply 60 days before or after event, but effective date cannot be prior to the event. Divorce: The event is the court ordered date of dissolution. 1st of the following month from a complete application submission if rec’d by the 15th and 1st of 2nd month if rec’d after the 15th. • A court order to provide health insurance for a child is not, by itself, a QLE. There must be an underlying event like loss of coverage to make the child eligible for an SEP. • Although application can be made prior to the event, the event itself must take place and coverage cannot begin prior to the event. Loss of retiree May apply 60 days before or after event, but effective date cannot be prior to the event. The event is the last day of coverage. 1st of the following month from a complete application submission if rec’d by the 15th and 1st of 2nd month if rec’d after the 15th. Although application can be made prior to the event, the event itself must take place and coverage cannot begin prior to the event. coverage due to former employer filing for bankruptcy protection Death of the policyholder May apply 60 days before loss of coverage or up to 60 days after loss of coverage. 1st of the following month from a complete application submission if rec’d by the 15th and 1st of 2nd month if rec’d after the 15th. Although application can be made prior to the event, the event itself must take place and coverage cannot begin prior to the event. The event date is the loss of actual coverage. Gaining status as a citizen, national or lawfully present individual 60 days after event 1st of the following month from a complete application submission if rec’d by the 15th and 1st of 2nd month if rec’d after the 15th. Discharge from active military duty 60 days after event 1st of the following month from a complete application submission if rec’d by the 15th and 1st of 2nd month if rec’d after the 15th. Qualifying Life Event SEP Window Effective date (subject to review) Additional Information Loss of coverage due to a loss permanent move outside of eligibility; the plan’s service area May apply 60 days before event or you and/or your eligible dependent become eligible for premium assistance, under your employer’s coverage, through Medicaid or CHIPup to 60 days after event. In addition, you may also be eligible for the following Special Enrollment Periods if you apply within thirty (30) days following the Special Enrollment event: if you or your dependent lose minimum essential coverage, coverage begins the first day 1st of the following monthmonth from a complete application submission if rec’d by the 15th and 1st of 2nd month if rec’d after the 15th. Coverage for Members who are Hospitalized on their Effective Date • Individual must have lost coverage due to the move. If you are no coverage in place, a move is not a QLE. • New address must have a different ZIP code to be considered eligible • Individual is eligible even if current coverage is not being cancelled due to the hospital on your effective date of move, or if never had coverage. • Although application can be made prior to the event, health care services related the event itself must take place and coverage cannot begin prior to such hospitalization are covered as long as: (a) you notify us of your hospitalization within forty-eight (48) hours the event. Move to a new service area May apply 60 days before event or up to 60 days after event. 1st of the effective date, or as soon as is reasonably possible; following month from a complete application submission if rec’d by the 15th and (b) covered health care services are received in accordance with 1st of 2nd month if rec’d after the terms, conditions, exclusions and limitations of this agreement15th. As always, benefits paid in such situations are subject • Although application can be made prior to the Coordination event, the event itself must take place and coverage cannot begin prior to the event. Loss of benefits provisions described in Section 6.0.coverage does not include voluntary termination of coverage or other loss due to—
Appears in 1 contract
Samples: www.alliantplans.com
Open Enrollment. An Open Enrollment Period will be held each year for coverage to be effective on the first day of the plan year. You and/or your eligible dependents may enroll at this time by making written application during the open enrollment period. Special Enrollment Period After your initial effective date, you may enroll your eligible dependents for coverage through a Special Enrollment Period after you experience a change in family status, a loss of private health coverage, or a change in eligibility for Medicaid or a State Children’s Health Insurance Program (CHIP) as described below. With a change in family status, you must make written application within the thirty (30) days following the event. You and/or your eligible dependents will qualify for a Special Enrollment Period as follows: if you get married, coverage begins the first day of the month following your marriage; if you have a child born to the family, coverage begins on the date of the child’s birth; if you have a child placed for adoption with your family, coverage begins on the date the child is placed for adoption with your family. In addition, if you lose your With a loss of private health coverage, you must make written application within the thirty (30) days following the event. Coverage begins the first day of the month following the loss of private health coverage. If you or your eligible dependents have a loss of coverage on the first day of the month, coverage under this agreement plan begins on the first day of that month. You or your eligible dependents will qualify for a Special Enrollment Period if each of the following conditions is met: The eligible person seeking coverage had other coverage at the time that he or she was first eligible for coverage under this agreement; The person waived coverage under this agreement plan due to being covered on another plan; and The coverage on the other plan is terminated as a result of: loss of eligibility for the coverage (including as a result of legal separation, divorce, death, termination of employment, or a reduction in the number of hours of employment), employer contributions towards such coverage being terminated, or COBRA, due to continuation, is exhausted. With a change in eligibility for Medicaid or a Children’s Health Insurance Program (CHIP), you must make written application within sixty (60) days following your change in eligibility. Coverage will begin on either the first day of the month following the event or, if the event occurs on the first day of a month, coverage under this agreement plan begins on the first day of that month. You and/or your eligible dependents will qualify for a Special Enrollment Period as follows: you and/or your eligible dependent are terminated from Medicaid or CHIP coverage due to a loss of eligibility; or you and/or your eligible dependent become eligible for premium assistance, under your employer/agent’s coverage, through Medicaid or CHIP. In addition, you may also be eligible for the following Special Enrollment Periods if you apply within thirty (30) days following the Special Enrollment event: if you or your dependent lose minimum essential coverage, coverage begins the first day of the following month. Coverage for Members who are Hospitalized on their Effective Date If you are in the hospital on your effective date of coverage, health care services related to such hospitalization are covered as long as: (a) you notify us of your hospitalization within forty-eight (48) hours of the effective date, or as soon as is reasonably possible; and (b) covered health care services are received in accordance with the terms, conditions, exclusions and limitations of this agreement. As always, benefits paid in such situations are subject to the Coordination of benefits provisions described in Section 6.0.
Appears in 1 contract
Samples: Subscriber Agreement
