19
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.