Special Enrollee means an Eligible Employee or Eligible Family Member who applies for coverage during a Special Enrollment Period following a Special Enrollment Event.
Special Enrollee. An Eligible Person who is entitled to and who requests special enrollment (as described in this Benefit Plan) within thirty (30) days of losing other certain vision coverage or acquiring a new Dependent as a result of marriage, birth, adoption or placement for adoption. Specialty Type Contact Lenses – Contact Lenses that are newer in the market than Standard Type Contact Lenses and require a specialty fitting. These lens types include, but not limited to, toric, multifocal and gas permeable lenses. Spectacle Lenses – Devices that correct refractive errors in vision which are intended to be mounted on Eyeglass Frames to be worn externally, involving a transparent medium bounded by two geometrically describable surfaces one of which shall be curved, that is, spherical, cylindrical, toroidal or aspheric. Spouse – The Subscriber’s legal Spouse. Standard Anti-Reflective Coating – A non-glare, clear lens coating that limits light reflection, which allows the maximum amount of light to pass through the lens and provides anti-reflection protection, such as Aegis™ Anti- Reflective Treatment or equivalent. Standard High-Index Lenses – Material with a higher index of refraction than plastic, which is used to create lenses that are thinner (by almost one-third) and flatter than what is possible with normal plastic. Standard Progressive Lenses – Lenses with variable power zones from far distance to near distance correction with an older, proven branded progressive lens design.
Special Enrollee means any Participant or Beneficiary who is eligible to enroll as described in the Evidence of Coverage under “Exceptions to Late Enrollment Rule” in the “Eligibility, Enrollment and Termination” section.
Examples of Special Enrollee in a sentence
If an individual enrolls as a Special Enrollee, any period before such Special Enrollment is not an Eligibility Waiting Period.
A Special Enrollment Period allows a Special Enrollee to enroll for coverage under this Plan upon a Special Enrollment Event as defined herein during a period of at least thirty-one (31) days following the Special Enrollment Event.
If an individual enrolls as a Special Enrollee, any period before such Special Enrollment is not a waiting period.
An Eligible Person who is not enrolled under this Plan may be permitted to enroll as a Special Enrollee if each of the following conditions is met: the Eligible Person must be eligible for coverage under the terms of this Plan; the Eligible Person must have declined enrollment under this Plan when offered;the Eligible Person lost coverage under a plan considered Creditable Coverage for HIPAA Portability purposes; the Eligible Person coverage described in c.
An Eligible Person who is not enrolled under this Plan may be permitted to enroll as a Special Enrollee if each of the following conditions is met: the Eligible Person must be eligible for coverage under the terms of this Plan; the Eligible Person must have declined enrollment under this Plan when offered; the Eligible Person lost coverage under a plan considered Creditable Coverage for HIPAA Portability purposes; the Eligible Person coverage described in c.
More Definitions of Special Enrollee
Special Enrollee means an Employee or Dependent who previously declined health coverage under the Plan and had coverage under another plan, but has experienced one of the following events:
Special Enrollee means an eligible Employee or Dependent who is entitled to and requests enrollment in the Plan in accordance with a Special Enrollment Period.
Special Enrollee means an individual who applies for coverage outside the Open Enrollment Period and who satisfies the conditions in (a), (b), (c), (d), or (e) below:
(a) The individual acquires a Dependent through birth, adoption, or placement for adoption; or
Special Enrollee means an individual who applies for coverage outside the Open Enrollment Period and who satisfies the conditions in (a), (b), (c), (d), or (e) below:
(a) The individual acquires a Dependent through birth, adoption, or placement for adoption; or
(b) The individual acquires a Spouse; or
(c) The individual meets each of the following three conditions:
(1) The individual was covered under another “group health plan” or health insurance policy that provided hospital, medical, or surgical expense benefits (as defined under ERISA § 733(a)(1)) at the time he/she was eligible to enroll; and
(2) The individual stated at the time of the Open Enrollment Period that the reason he/she declined coverage under this Plan was because he/she had coverage under another group health plan or health insurance policy that provided hospital, medical, or surgical expense benefits. The Plan may require that this explanation of declination be in writing, but only if the individual was first provided notice of this requirement and the consequences of failing to provide it; and
(3) The individual has lost coverage under another health insurance policy or “group health plan” (including Tricare) that provides hospital, medical or surgical expenses benefits (as defined under ERISA § 733(a)(1)) as a result of a termination of employment, reduction in the number of hours of employment, termination of employer contributions toward such coverage, death of a spouse, divorce, legal separation, end of active military service, or exhaustion of COBRA continuation coverage;
(i) A loss of coverage based on the failure to pay required premiums under the alternative coverage is not a valid basis for creating special enrollment rights in this Plan; and
(ii) An individual who has been receiving coverage pursuant to Tricare will be entitled to special enrollment rights under this Plan only upon the loss of his/her Tricare coverage. Special enrollment rights are not automatically triggered merely by virtue of the end of active military service; or
(d) The individual becomes eligible for a state premium assistance subsidy under a group health plan of the Plan Sponsor from either Medicaid or a state’s children’s health insurance program (SCHIP); or
(e) The individual loses eligibility for coverage under Medicaid or SCHIP. In addition, enrollment must be requested within the timeframe specified in the Adoption Agreement. In no case will the period be shorter than 30 days for the event described in (a), (b) o...
Special Enrollee. An Eligible Person who is entitled to and who requests special enrollment (as described in this Benefit Plan) within thirty (30) days of losing other certain vision coverage or acquiring a new Dependent as a result of marriage, birth, adoption or placement for adoption. Specialty Type Contact Lenses – Contact Lenses that are newer in the market than Standard Type Contact Lenses and require a specialty fitting. These lens types include, but not limited to, toric, multifocal and gas permeable lenses. Spectacle Lenses – Devices that correct refractive errors in vision which are intended to be mounted on Eyeglass Frames to be worn externally, involving a transparent medium bounded by two geometrically describable surfaces one of which shall be curved, that is, spherical, cylindrical, toroidal or aspheric. Standard Anti-Reflective Coating – A non-glare, clear lens coating that limits light reflection, which allows the maximum amount of light to pass through the lens and provides anti-reflection protection, such as Aegis™ Anti- Reflective Treatment or equivalent. Standard High-Index Lenses – Material with a higher index of refraction than plastic, which is used to create lenses that are thinner (by almost one-third) and flatter than what is possible with normal plastic. Standard Progressive Lenses – Lenses with variable power zones from far distance to near distance correction with an older, proven branded progressive lens design.
Special Enrollee means an employee or Dependent who is entitled to Special Enrollment and requests Special Enrollment (i) within thirty (30) days of losing other health coverage, or (ii) for a newly added Dependent, within thirty (30) days of the marriage, birth, adoption, or placement of adoption.
Special Enrollee means any Participant or Beneficiary who is eligible to enroll as described in the Evidence of Coverage under “Exceptions to Late Enrollment Rule” in the “Eligibility, Enrollment and Termination” section. PREPARATION OF SBCs: Health Net shall prepare and deliver to Group an SBC for each Health Net health benefit plan which Group offers to Covered and Eligible Persons. Health Net shall use reasonable commercial efforts to provide required SBCs to Group before Group’s open enrollment process for the next year beginning on or after September 23, 2012 is scheduled to commence. Health Net shall prepare and deliver a modified SBC to Group whenever Health Net determines that material modifications must be made to a previously delivered SBC.