Common use of Special Enrollment Procedures Clause in Contracts

Special Enrollment Procedures. a. A covered employee’s eligible dependents, or an eligible employee on behalf of himself and his eligible dependents, must enroll by submitting any application or enrollment forms acceptable to or provided by AvMed, along with supporting documentation as we may require, within the following timeframes; otherwise, the eligible employee and/or eligible dependents must wait until the Subscribing Group’s next annual open enrollment period. i. Within 30 days after the date of the loss of other coverage (proof of continuous other coverage is required); ii. Within 30 days after the date of marriage (certificate of marriage is required); iii. Within 30 days after the date of placement in the Subscriber’s home for, or adoption of, a child other than a newborn (proof of placement or adoption is required); iv. Within 60 days after gaining eligibility for Premium assistance, or loss of eligibility, under Medicaid or CHIP (proof of such change in eligibility is required); v. Within 60 days after the birth of a child, including an adopted newborn child, as described below (for an adopted newborn, a copy of a written agreement to adopt, entered into by the Subscriber prior to the birth of such child, is required): 1) If notice is given within 30 days after the date of birth, no additional Premium will be charged for the newborn child’s coverage during the 30-day period immediately following the newborn’s birth. 2) If notice is received within 31 to 60 days after the date of birth, we will charge the applicable Premium from the date of birth. You must pay the additional Premium for coverage to be provided for the newborn child. 3) If notice is not received within 60 days after the date of birth, the child may not be enrolled until the Subscribing Group’s next open enrollment period.