Special Enrollment Periods Sample Clauses

Special Enrollment Periods. Outside of the annual open enrollment period, You, Your Spouse or Child can enroll for coverage within 30 days of the date the Subscriber gains a Dependent through marriage, birth, adoption, or placement for adoption. We must receive notice and any premium payment within 30 days of one of these events. If You have a newborn or adopted newborn Child and We receive notice of such birth within 30 days thereafter, coverage for Your newborn starts at the moment of birth; otherwise coverage begins on the date on which We receive notice. Your adopted newborn Child will be covered from the moment of birth if You take physical custody of the infant as soon as the infant is released from the Hospital after birth and You file a petition pursuant to Section 115-c of the New York Domestic Relations Law within 30 days of the infant’s birth; and provided further that no notice of revocation to the adoption has been filed pursuant to Section 115-b of the New York Domestic Relations Law, and consent to the adoption has not been revoked. If You have individual or individual and Spouse coverage You must also notify Us of Your desire to switch to parent and child/children or family coverage and pay any additional Premium within 30 days of the birth or adoption in order for coverage to start at the moment of birth. Otherwise, coverage begins on the date on which We receive notice provided that You pay any additional Premium when due. In all other cases, the effective date of Your coverage will depend on when We receive Your selection. If Your selection is received between the first and fifteenth day of the month, Your coverage will begin on the first day of the following month, as long as Your applicable Premium payment is received by then. If Your selection is received between the sixteenth day and the last day of the month, Your coverage will begin on the first day of the second month, as long as Your applicable Premium payment is received by then.

Special Enrollment Periods. Allows declining participants to later enroll into the plan like a new employee, if certain criteria are met such as: a) marriage or divorce; b) birth, adoption or placement for adoption of a child; c) death of a spouse or child; d) change in spouse’s employment status; e) change in employee’s employment status; f) change in a dependent’s eligibility; g) unpaid leave of absence taken by the employee or spouse; h) loss of health insurance.

Special Enrollment Periods. Outside of the annual open enrollment period, You, the Subscriber, Your Spouse, or Child, can enroll for coverage within 60 days prior to or after the occurrence of one (1) of the following events: 1. You or Your Spouse or Child involuntarily lose minimum essential coverage, including COBRA, including if You are enrolled in a non-calendar year group health plan or individual health insurance coverage, even if You have the option to renew the coverage; 2. You, Your Spouse or Child are determined newly eligible for advance payments of the Premium Tax Credit because coverage You are enrolled in will no longer be employer-sponsored minimum essential coverage, including as a result of Your employer discontinuing or changing available coverage within the next 60 days, provided that You are allowed to terminate existing coverage 3. You, Your Spouse or Child lose eligibility for Medicaid coverage, including Medicaid coverage for pregnancy-related services and Medicaid coverage for the medically needy, but not including other Medicaid programs that do not provide coverage for primary or specialty care; 4. You, Your Spouse or Child become eligible for new qualified dental plans because of a permanent move and You, Your Spouse or Child had minimum essential coverage for one (1) or more days during the 60 days before the move; or 5. You, Your Spouse or Child are no longer incarcerated. Outside of the annual open enrollment period, You, the Subscriber, Your Spouse, or Child, can enroll for coverage within 60 days after the occurrence of one (1) of the following events: 1. You, Your Spouse or Child’s enrollment or non-enrollment in another qualified dental plan was unintentional, inadvertent or erroneous and was the result of the error, misrepresentation, or inaction of an officer, employee, or agent of the NYSOH, or a non-NYSOH entity providing enrollment assistance or conducting enrollment activities, as evaluated and determined by the NYSOH; 2. You, Your Spouse or Child adequately demonstrate to the NYSOH that another qualified dental plan in which You were enrolled substantially violated a material provision of its contract; 3. You gain a Dependent or become a Dependent through birth, adoption or placement for adoption, or placement in xxxxxx care or through a child support order or other court order; however, xxxxxx children and Children for whom You are a legal guardian are not covered under this Contract; 4. You gain a Dependent or become a Dependent through marr...

Special Enrollment Periods. Outside of the annual open enrollment period, You, the Subscriber, Your Spouse, or Child, can enroll for coverage within 60 days prior to or after the occurrence of one (1) of the following events: 1. You or Your Spouse or Child involuntarily lose minimum essential coverage, including COBRA and state continuation coverage, including if You are enrolled in a non-calendar year group health plan or individual health insurance coverage, even if You have the option to renew the coverage;

Special Enrollment Periods. Consumers can qualify for a Special Enrollment Period (SEP) to enroll for health insurance coverage if they meet certain eligibility criteria. Below is a list of the categories of SEPs currently available.

Special Enrollment Periods. In general, a qualified individual has 60 days to report certain life changes, known as “qualifying events” to the plan or by using Xxxxxxxx’s Enhanced Direct Enrollment tool. Qualified Individuals may be granted a Special Enrollment Period where they may enroll in or change to a different plan during the current plan year if they have a qualifying event. Qualifying events include:

Special Enrollment Periods. An Eligible Employee or Eligible Dependent will not be considered a Late Enrollee if: 1. The Eligible Employee or Eligible Dependent meets each of the following: a) The individual was covered under Qualifying Previous Coverage at the time of the initial enrollment period. b) The individual lost coverage under Qualifying Previous Coverage as a result of termination of employment or eligibility, the involuntary termination of the Qualifying Previous Coverage. c) The individual requests enrollment within thirty (30) days after termination of the Qualifying Previous Coverage. 2. The individual is employed by an employer that offers multiple dental plans and the individual elects a different plan during an open enrollment period. 3. A court has issued a court order requiring that coverage be provided for an Eligible Dependent by an Enrollee under this Contract, and application for enrollment is made within thirty (30) days after issuance of the court order. 4. The individual first becomes eligible. 5. The Eligible Employee and/or Eligible Dependent become eligible for a premium assistance subsidy under Medicaid or the Children's Health Insurance Program (CHIP) and coverage under this Contract is requested no later than sixty (60) days after the date the Eligible Employee and/or Eligible Dependent is determined to be eligible for such assistance.

Special Enrollment Periods. An Eligible Dependent will not be considered a Late Enrollee if: 1. The Eligible Dependent meets each of the following: a) The individual was covered under Qualifying Previous Coverage at the time of the initial enrollment period; b) The individual lost coverage under Qualifying Previous Coverage as a result of termination of employment or eligibility, the involuntary termination of the Qualifying Previous Coverage; and c) The individual requests enrollment within thirty (30) days after termination of the Qualifying Previous Coverage. 2. The individual is employed by an employer that offers multiple dental plans and the individual elects a different plan during an open enrollment period. 3. A court has issued a court order requiring that coverage be provided for an Eligible Dependent by an Enrollee under this Contract, and application for enrollment is made within thirty (30) days after issuance of the court order. 4. The individual first becomes eligible. 5. The Eligible Dependent become eligible for a premium assistance subsidy under Medicaid or the Children's Health Insurance Program (CHIP) and coverage under this Contract is requested no later than sixty (60) days after the date the Eligible Dependent is determined to be eligible for such assistance.

Special Enrollment Periods. Special enrollment is allowed for certain individuals who lose coverage. Special enrollment is also allowed with respect to certain Dependent beneficiaries. If only the Subscriber is eligible under this Evidence of Coverage and Dependents are not eligible to enroll, special enrollment period for a Spouse /Dependent child are not applicable. A. Special enrollment for certain individuals who lose coverage: 1. CareFirst will permit current employees and Dependents to enroll for coverage without regard to the dates on which an individual would otherwise be able to enroll under this Evidence of Coverage. 2. Individuals eligible for special enrollment. a. When employee loses coverage. A current employee and any Dependents (including the employee's Spouse) each is eligible for special enrollment in any benefit package offered by the Group (subject to Group eligibility rules conditioning Dependent enrollment on enrollment of the employee) if: i. The employee and the Dependents are otherwise eligible to enroll; ii. When coverage was previously offered, the employee had coverage under any group health plan or health insurance coverage; and iii. The employee satisfies the conditions of paragraph A.2.c. i., ii., or iii. of this section, and if applicable, paragraph A.2.c. iv. of this section. b. When Dependent loses coverage. i. A Dependent of a current employee (including the employee's Spouse) and the employee each are eligible for special enrollment in any benefit package offered by the Group (subject to Group eligibility rules conditioning Dependent enrollment on enrollment of the employee) if: 1) The Dependent and the employee are otherwise eligible to enroll; 2) When coverage was previously offered, the Dependent had coverage under any group health plan or health insurance coverage; and 3) The Dependent satisfies the conditions of paragraph A.2.c. i., ii., or iii., of this section, and if applicable, paragraph A.2.c.iv. of this section. ii. However, CareFirst is not required to enroll any other Dependent unless the Dependent satisfies the criteria of this paragraph A. 2.b., or the employee satisfies the criteria of paragraph A.2.a. of this section.

Special Enrollment Periods enrollment period occurs when a person experiences a triggering event. If You experience one of the triggering events listed below, You can enroll for coverage and enroll Your eligible Dependent(s) during a Special Enrollment Period instead of waiting for the next Annual Open Enrollment Period. Triggering events for a special enrollment period are: ▪ An eligible individual, and any dependent(s), loses his or her minimum essential coverage; or ▪ An eligible individual and his or her dependent(s) lose employer-sponsored health plan coverage due to voluntary or involuntary termination of employment for reasons other than misconduct, or due to a reduction in work hours; or ▪ An eligible individual gaining or becoming a dependent through marriage, birth, adoption or placement of adoption; or ▪ An eligible dependent spouse or child loses coverage under an employer-sponsored health plan due to employee’s becoming entitled to Medicare, divorce, legal separation of the covered employee, and death of the covered employee; ▪ An eligible individual loses his or her dependent child status under a parent’s employer- sponsored health plan; or ▪ An individual who was not previously a citizen, national or lawfully present individual gains such status, is only applicable to the marketplace; or ▪ An eligible individual’s enrollment or non-enrollment in a qualified health plan is unintentional, inadvertent, or erroneous and as the result of the error, misrepresentation, or inaction of an officer, employee or agent of the state marketplace, or of the Department of Health and Human Services (HHS), or its instrumentalities as determined by the marketplace. In such cases, the marketplace may take such action as may be necessary to correct or eliminate the effects of such error, misrepresentation or action; or ▪ An eligible individual adequately demonstrates to the marketplace that the qualified health plan in which he or she is enrolled substantially violated a material provision of its contract in relation to that person; or ▪ An eligible individual is determined newly eligible or newly ineligible for advance payments of the premium tax credit or has a change in eligibility for cost-sharing reductions, regardless of whether such individual is already enrolled in a qualified health plan. The marketplace must permit individuals whose existing coverage through an eligible employer-sponsored plan will no longer be affordable or provide minimum value for his or her employer’s upcomin...