Common use of Special Enrollment Period Clause in Contracts

Special Enrollment Period. An eligible individual and eligible dependents may be enrolled during a special enrollment period. A special enrollment period may apply when an eligible individual or eligible dependent loses other health coverage or when an eligible individual acquires a new eligible dependent through marriage, birth, adoption or placement for adoption. An eligible individual or an eligible dependent may be enrolled during a special enrollment period, if requirements a, b, c and d are met: a. the eligible individual or the eligible dependent was covered under another group health plan or other health insurance coverage when initially eligible for coverage under HMO; b. the eligible individual or eligible dependent previously declined coverage in writing under HMO; c. the eligible individual or eligible dependent loses coverage under the other group health plan or other health insurance coverage for one of the following reasons: i. the other group health coverage is COBRA continuation coverage under another plan, and the COBRA continuation coverage under that other plan has since been exhausted; or ii. the other coverage is a group health plan or other health insurance coverage, and the other coverage has been terminated as a result of loss of eligibility for the coverage or employer contributions towards the other coverage have been terminated. • termination of HMO coverage due to Member action- movement outside of the HMO’s service area; and also the termination of health coverage including Non-HMO, due to plan termination. Loss of eligibility does not include a loss due to failure of the individual or the participant to pay Premiums on a timely basis or due to termination of coverage for cause as referenced in the Termination of Coverage section of this EOC; and d. the eligible individual or eligible dependent enrolls within 31 days of the loss. The Effective Date of Coverage will be the first day of the first calendar month following the date the completed request for enrollment is received. The eligible individual or the eligible dependent enrolling during a special enrollment period will not be subject to late enrollment provisions, if any, described in this EOC.

Special Enrollment Period. An eligible individual and eligible dependents may be enrolled during a special enrollment periodperiods. A special enrollment period may apply when an eligible individual or eligible dependent loses other health coverage or when an eligible individual acquires a new eligible dependent through marriage, birth, adoption or placement for adoption. An eligible individual or an eligible dependent may be enrolled during a special enrollment period, if requirements a, b, c and d are met: a. the eligible individual or the eligible dependent was covered under another group health plan or other health insurance coverage when initially eligible for coverage under HMO; b. the eligible individual or eligible dependent previously declined coverage in writing under HMO; c. the eligible individual or eligible dependent loses coverage under the other group health plan or other health insurance coverage for one 1 of the following reasons: i. the other group health coverage is COBRA continuation coverage under another plan, and the COBRA continuation coverage under that other plan has since been exhausted; or ii. the other coverage is a group health plan or other health insurance coverage, and the other coverage has been terminated as a result of loss of eligibility for the coverage or employer contributions towards the other coverage have been terminated. • termination of HMO coverage due to Member action- movement outside of the HMO’s service area; and also the termination of health coverage including Non-HMO, due to plan termination. Loss of eligibility does not include a loss due to failure of the individual or the participant to pay Premiums on a timely basis or due to termination of coverage for cause as referenced in the Termination of Coverage section of this EOCCertificate; and d. the eligible individual or eligible dependent enrolls within 31 days of the loss. The Effective Date of Coverage will be the first day of the first calendar month following the date the completed request for enrollment is received. The eligible individual or the eligible dependent enrolling during a special enrollment period will not be subject to late enrollment provisions, if any, described in this EOCCertificate. When a new eligible dependent is acquired through marriage, birth, adoption or placement for adoption, the new eligible dependent (and, if not otherwise enrolled, the eligible individual and other eligible dependents) may be enrolled during a special enrollment period. The special enrollment period is a period of 31 days, beginning on the date of the marriage, birth, adoption or placement for adoption (as the case may be). If a completed request for enrollment is made during that period, the Effective Date of Coverage will be: The eligible individual or the eligible dependents enrolling during a special enrollment period will not be subject to late enrollment provisions, if any, described in this Certificate.

Special Enrollment Period. An eligible individual and eligible dependents may be enrolled during a special enrollment periodperiods. A special enrollment period may apply when an eligible individual or eligible dependent loses other health coverage or when an eligible individual acquires a new eligible dependent through marriage, birth, adoption or placement for adoption. An eligible individual or an eligible dependent may be enrolled during a special enrollment period, if requirements a, b, c and d are met: a. the eligible individual or the eligible dependent was covered under another group health plan or other health insurance coverage when initially eligible for coverage under HMO; b. the eligible individual or eligible dependent previously declined coverage in writing under HMO; c. the eligible individual or eligible dependent loses coverage under the other group health plan or other health insurance coverage for one 1 of the following reasons: i. the other group health coverage is COBRA continuation coverage under another plan, and the COBRA continuation coverage under that other plan has since been exhausted; or ii. the other coverage is a group health plan or other health insurance coverage, and the other coverage has been terminated as a result of loss of eligibility for the coverage or employer contributions towards the other coverage have been terminated. • termination of HMO coverage due to Member action- action/ movement outside of the HMO’s service area; and also the termination of health coverage including Non-HMO, due to plan termination. ; Loss of eligibility does not include a loss due to failure of the individual or the participant to pay Premiums on a timely basis or due to termination of coverage for cause as referenced in the Termination of Coverage section of this EOCCertificate; and d. the eligible individual or eligible dependent enrolls within 31 days of the loss. The Effective Date of Coverage will be the first day of the first calendar month following the date the completed request for enrollment is received. The eligible individual or the eligible dependent enrolling during a special enrollment period will not be subject to late enrollment provisions, if any, described in this EOCCertificate.

Special Enrollment Period. An eligible individual and eligible dependents may be enrolled during a special enrollment periodSpecial Enrollment Period. A special enrollment period Special Enrollment Period may apply when an eligible individual or eligible dependent dependent a. loses other health coverage or when an eligible individual acquires a new eligible dependent through marriage, birth, adoption or placement for adoption. An ; or b. the eligible individual or an eligible dependent may be enrolled during a special enrollment period, if requirements a, b, c and d are metbecomes eligible for State premium assistance in connection with coverage under the HMO. Special Enrollment Period for Certain Individuals Who Lose Other Health Coverage: a. the eligible individual or the eligible dependent was covered under another group health plan or other health insurance coverage when initially eligible for coverage under HMO; b. the eligible individual or eligible dependent previously declined coverage in writing under HMO; c. the eligible individual or eligible dependent loses coverage under the other group health plan or other health insurance coverage for one of the following reasons: i. the other group health coverage is COBRA continuation coverage under another plan, and the COBRA continuation coverage under that other plan has since been exhausted; or; ii. the other coverage is a group health plan or other health insurance coverage, and the other coverage has been terminated as a result of loss of eligibility for the coverage or employer contributions towards the other coverage have been terminated; or iii. the other health insurance coverage is Medicaid or an S-Chip plan and the eligible individual or eligible dependent no longer qualifies for such coverage. Loss of eligibility includes the following: • termination of HMO coverage due to Member action- movement outside of the HMO’s service area; and also the termination of health coverage including Non-HMO, due to plan termination. Loss of eligibility does not include a loss due to failure of the individual or the participant to pay Premiums on a timely basis or due to termination of coverage for cause as referenced in the Termination of Coverage section of this EOC; and d. Certificate. To be enrolled in HMO during a Special Enrollment Period, the eligible individual or eligible dependent enrolls within 31 days of the loss. The Effective Date of Coverage will be the first day of the first calendar month following the date the completed request for enrollment is received. The eligible individual or the eligible dependent enrolling during a special enrollment period will not be subject to late enrollment provisions, if any, described in this EOC.must enroll within:

Special Enrollment Period. An eligible individual and eligible dependents may be enrolled during a special enrollment periodSpecial Enrollment Period. A special enrollment period Special Enrollment Period may apply when an eligible individual or eligible dependent loses other health coverage or when an eligible individual acquires a new eligible dependent through marriage, birth, adoption or placement for adoption. An eligible individual or an eligible dependent may be enrolled during a special enrollment periodSpecial Enrollment Period, if requirements athe following requirements, bas applicable, c and d are met: a. the eligible individual or the eligible dependent was covered under another group health plan or other health insurance coverage when initially eligible for coverage under HMO;; or b. the eligible individual or eligible dependent previously declined coverage in writing under HMO; c. . In addition, one of the following items must also apply: • the eligible individual or eligible dependent becomes eligible for State premium assistance in connection with coverage under HMO; or • the eligible individual or eligible dependent loses coverage under the other group health plan or other health insurance coverage for one of the following reasons: i. the other group health coverage is COBRA continuation coverage under another plan, and the COBRA continuation coverage under that other plan has since been exhausted; or ii. the other coverage is a group health plan or other health insurance coverage, and the other coverage has been terminated as a result of loss of eligibility for the coverage or employer contributions towards the other coverage have been terminated; or iii. the other health insurance coverage is Medicaid or an S-Chip plan and the eligible individual or eligible dependent no longer qualifies for such coverage. Loss of eligibility includes the following: • termination of HMO coverage due to Member action- action/movement outside of the HMO’s service area; and also the termination of health coverage including Non-Non- HMO, due to plan termination. ; Loss of eligibility does not include a loss due to failure of the individual or the participant to pay Premiums on a timely basis or due to termination of coverage for cause as referenced in the Termination of Coverage section of this EOC; and d. . To be enrolled in HMO during a Special Enrollment Period, the eligible individual or eligible dependent enrolls within 31 days of the loss. The Effective Date of Coverage will be the first day of the first calendar month following the date the completed request for enrollment is received. The eligible individual or the eligible dependent enrolling during a special enrollment period will not be subject to late enrollment provisions, if any, described in this EOC.must enroll within:

Special Enrollment Period. An eligible individual and eligible dependents may be enrolled during a special enrollment period. A special enrollment period may apply when an eligible individual or eligible dependent loses other health coverage or when an eligible individual acquires a new eligible dependent through marriage, birth, adoption or placement for adoption. An eligible individual or an eligible dependent may be enrolled during a special enrollment period, if requirements (a), (b), c (c), and d (d) are met: a. the eligible individual or the eligible dependent was covered under another group health plan or other health insurance coverage when initially eligible for coverage under HMO; b. the eligible individual or eligible dependent previously declined coverage in writing under HMO; c. the eligible individual or eligible dependent loses coverage under the other group health plan or other health insurance coverage for one of the following reasons: i. the other group health coverage is COBRA continuation coverage under another plan, and the COBRA continuation coverage under that other plan has since been exhausted; , or ii. the other coverage is a group health plan or other health insurance coverage, and the other coverage has been terminated as a result of loss of eligibility for the coverage or employer contributions towards the other coverage have been terminated. • Loss of eligibility includes a loss of coverage as a result of legal separation, divorce, death, termination of HMO coverage due to Member action- movement outside employment, reduction in the number of hours of employment, in the case of the HMOHealthy Families Program exceeding the program’s service area; income or age limits, and also any loss of eligibility after a period that is measured by reference to any of the termination of health coverage including Non-HMO, due to plan terminationforegoing. Loss of eligibility does not include a loss due to failure of the individual or the participant to pay Premiums on a timely basis or due to termination of coverage for cause as referenced in the Termination of Coverage section of this EOC; : and d. the eligible individual or eligible dependent enrolls within 31 days of the loss. The Effective Date of Coverage will be the first day of the first calendar month following the date the completed request for enrollment is received. The eligible individual or the eligible dependent enrolling during a special enrollment period will not be subject to late enrollment provisions, if any, described in this EOC.

Special Enrollment Period. An eligible individual and eligible dependents may be enrolled during a special enrollment periodperiods. A special enrollment period may apply when an eligible individual or eligible dependent loses other health coverage or when an eligible individual acquires a new eligible dependent through marriage, birth, adoption or placement for adoption. An eligible individual or an eligible dependent may be enrolled during a special enrollment period, if requirements a, b, c and d are met: a. the eligible individual or the eligible dependent was covered under another group health plan or other health insurance coverage when initially eligible for coverage under HMO; b. the eligible individual or eligible dependent previously declined coverage in writing under HMO; c. the eligible individual or eligible dependent loses coverage under the other group health plan or other health insurance coverage for one 1 of the following reasons: i. the other group health coverage is COBRA continuation coverage under another plan, and the COBRA continuation coverage under that other plan has since been exhausted; or ii. the other coverage is a group health plan or other health insurance coverage, and the other coverage has been terminated as a result of loss of eligibility for the coverage or employer contributions towards the other coverage have been terminated. • termination of HMO coverage due to Member action- movement outside of the HMO’s service area; and also the termination of health coverage including Non-HMO, due to plan termination. Loss of eligibility does not include a loss due to failure of the individual or the participant to pay Premiums on a timely basis or due to termination of coverage for cause as referenced in the Termination of Coverage section of this EOCCertificate; and d. the eligible individual or eligible dependent enrolls within 30-31 days of the loss. The Effective Date of Coverage will be the first day of the first calendar month following the date the completed request for enrollment is received. The eligible individual or the eligible dependent enrolling during a special enrollment period will not be subject to late enrollment provisions, if any, described in this EOCCertificate.

Special Enrollment Period. An eligible individual employee and his or her eligible dependents who have not previously enrolled for coverage may be enrolled able to enroll during a special enrollment period31-day Special Enrollment Period. A special enrollment period may apply when an eligible individual or eligible dependent loses other health This coverage or when an eligible individual acquires a new eligible dependent through marriage, birth, adoption or placement for adoption. An eligible individual or an eligible dependent may be enrolled during a special enrollment period, if requirements a, b, c and d are metis available only to: a. 1. The eligible employee and/or dependents who declined EHA coverage at the eligible individual or the eligible dependent time enrollment was previously offered because they were covered under another group health plan or other health insurance coverage when initially eligible for and subsequently lost that coverage under HMO; b. the eligible individual or eligible dependent previously declined coverage in writing under HMO; c. the eligible individual or eligible dependent loses coverage under the other group health plan or other health insurance coverage for one of the following reasonsbecause: i. the a. The other group health coverage is was COBRA continuation coverage under another plan, and the COBRA continuation coverage under that other plan which now has since been exhausted; or ii. the b. The other coverage is a group health plan or other health insurance was not COBRA continuation coverage, and the other coverage has been terminated as a result of a loss of eligibility for the coverage or employer contributions towards the other coverage have been terminatedeligibility. • termination of HMO coverage due to Member action- movement outside of the HMO’s service area; and also the termination of health coverage including Non-HMOFor this purpose, due to plan termination. Loss a loss of eligibility does not include result from a voluntary termination of coverage, a failure to pay premiums or reasons determined to be "for cause." A loss of eligibility includes a loss due to failure moving out of the individual service area of an HMO, or the participant to pay Premiums on a timely basis or loss due to the exhaustion of a lifetime limit on all benefits. c. The other coverage was not COBRA continuation coverage and the employer ceased to make contributions for the other coverage; or The employee must have declined enrollment for coverage in writing when this coverage was last offered, citing the other coverage as the reason for declination. This provision requires the Group Applicant required such a statement and provided notice and information about the consequences of non-compliance with such requirement (see Part I.A.4). 2. A person who becomes an eligible dependent through birth, adoption, placement for adoption or marriage. An eligible employee or spouse who has not previously enrolled may also enroll with the new dependent at this time. A Special Enrollment Period of 60 days is available to an employee or his or her eligible dependents who are eligible but not enrolled, under either of the following conditions: 1. The employee or dependent is covered under Medicaid of a State Child Health Insurance program (SCHIP), and such coverage is terminated as a result of loss of eligibility. 2. The employee or dependent becomes eligible for premium assistance under Medicaid or a State Child Health Insurance Program (SCHIP) with respect to coverage under the EHA group health plan. The employee must request enrollment no later than 60 days after the termination of coverage for cause as referenced described in the Termination of Coverage section of this EOC; and d. the eligible individual paragraph a., or eligible dependent enrolls within 31 no later than 60 days of the loss. The Effective Date of Coverage will be the first day of the first calendar month following after the date the completed request employee or dependent is determined eligible for enrollment is received. The eligible individual or the eligible dependent enrolling during a special enrollment period will not be subject to late enrollment provisions, if any, premium assistance as described in paragraph b. The employee must also enroll (if not already enrolled) in order to enroll his or her eligible dependents at this EOCtime.

Special Enrollment Period. An eligible individual and eligible dependents person who has not previously enrolled for coverage, may be enrolled able to enroll during a special enrollment periodSpecial Enrollment Period. 1. A special enrollment period may apply when Special Enrollment Period of 31 days is available to an eligible individual person who declined coverage under this Contract at the time enrollment was previously offered because he or eligible dependent loses she was covered under other group health plan or health insurance coverage and who has subsequently lost that coverage because of any of the following: a. The other coverage was COBRA continuation coverage which has now been exhausted. b. The other coverage was not COBRA continuation coverage, and the coverage has been terminated resulting from loss of eligibility, including loss because of death of a spouse, divorce or legal separation, termination of employment or reduction in hours of employment, or the prior plan no longer offers any benefits to the class of individuals that includes the person. (A voluntary termination of coverage, a failure to pay premiums, or reasons determined to be "for cause," do not qualify as a loss of eligibility for coverage under this paragraph C.). A loss of eligibility for coverage shall include that which is due to moving out of the service area of an HMO or other arrangement that only provides benefits to individuals who reside, live or work in the service area; or a loss due to the exhaustion of a lifetime limit on all benefits. c. The other coverage was not COBRA continuation coverage and the employer ceased to make a contribution for other health insurance coverage. Persons requesting enrollment during this Special Enrollment Period must do so within 31 days of the loss of other coverage, or late enrollment provisions may apply. The Subscriber must enroll (if not already covered) in order to enroll his or her Eligible Dependents during this Special Enrollment Period. If required by the Group, the Subscriber must have waived enrollment for coverage in writing when coverage under this Contract was last offered, citing the other coverage as the reason for declination. 2. A Special Enrollment Period of 31 days is available to a Subscriber who acquires an Eligible Dependent through birth, adoption, placement for adoption or when marriage. A Subscriber who is eligible, but who has not previously enrolled, may enroll at this time, whether or not the new Eligible Dependent(s) is enrolled. Likewise, an eligible individual acquires a spouse who has not previously enrolled may enroll at this time, whether or not the new eligible dependent through Eligible Dependent child is enrolled. Persons requesting enrollment during this Special Enrollment Period must do so within 31 days of the marriage, birth, adoption or placement for adoption. An eligible individual , or an eligible dependent late enrollment provisions may be enrolled during a special enrollment period, if requirements a, b, c and d are met: a. the eligible individual or the eligible dependent was covered under another group health plan or other health insurance coverage when initially eligible for coverage under HMO; b. the eligible individual or eligible dependent previously declined coverage in writing under HMO; c. the eligible individual or eligible dependent loses coverage under the other group health plan or other health insurance coverage for one of the following reasons: i. the other group health coverage is COBRA continuation coverage under another plan, and the COBRA continuation coverage under that other plan has since been exhausted; or ii. the other coverage is a group health plan or other health insurance coverage, and the other coverage has been terminated as a result of loss of eligibility for the coverage or employer contributions towards the other coverage have been terminated. • termination of HMO coverage due to Member action- movement outside of the HMO’s service area; and also the termination of health coverage including Non-HMO, due to plan termination. Loss of eligibility does not include a loss due to failure of the individual or the participant to pay Premiums on a timely basis or due to termination of coverage for cause as referenced in the Termination of Coverage section of this EOC; and d. the eligible individual or eligible dependent enrolls within 31 days of the lossapply. The Effective Date of Coverage will be the first day of the first calendar month following the date the completed request for enrollment is received. The eligible individual Subscriber must also enroll (if not already covered) in order to enroll his or the eligible dependent enrolling her Eligible Dependents during a special enrollment period will not be subject to late enrollment provisions, if any, described in this EOCSpecial Enrollment Period.