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NOTICES

Notices

Important information for you and your families

HIPAA - Special Enrollment Notice

If you are declining enrollment for yourself or your dependents (including your 

spouse) because of other health insurance or group health plan coverage, you 

may be able to enroll yourself and your dependents in this plan if you or your 

dependents lose eligibility for that other coverage (or if the employer stops 

contributing toward your or your dependents’ other coverage). However, you 

must request enrollment within 30 days after your or your dependents’ other 

coverage ends (or after the employer stops  

contributing toward the other coverage). 

In addition, if you have a new dependent as a result of marriage, birth, 

adoption, or placement for adoption, you may be able to enroll yourself and 

your dependents. However, you must request enrollment within 30 days after 

the marriage, birth, adoption, or placement for adoption. 

Finally, you and/or your dependents may have special enrollment rights if 

coverage is lost under Medicaid or a State health insurance (“SCHIP”) program, 

or when you and/or your dependents gain eligibility for state premium 

assistance. You have 60 days from the occurrence of one of these events to 

notify the company and enroll in  

the plan.