Page 39 - Aegion PPO SPDs
P. 39
Lost employer contributions towards the cost of the other coverage;
Are now eligible for coverage due to marriage, birth, adoption, or placement for adoption.
Important Notes About Special Enrollment:
Individuals enrolled during special enrollment periods are not Late Enrollees.
Individuals or Dependents must request coverage within 30 days of a qualifying event (i.e., marriage,
exhaustion of COBRA, etc.).
Medicaid and CHIP Special Enrollment/Special Enrollees
Eligible Employees and Dependents may also enroll under two additional circumstances:
the Employee’s or Dependent’s Medicaid or Children’s Health Insurance Program (CHIP) coverage is
terminated as a result of loss of eligibility; or
the Employee or Dependent becomes eligible for a subsidy (state premium assistance program).
The Employee or Dependent must request Special Enrollment within 60 days of the loss of Medicaid/CHIP
or of the eligibility determination.
Annual Open Enrollment Period
Eligible employees and/or family members who were not covered under this plan and who do not qualify
as special enrollees can enroll for coverage during the open enrollment period generally in November each
year. Coverage will be effective January 1 of the following year.
Family and Medical Leave Act
If the Employer is subject to the requirements of the Family and Medical Leave Act (FMLA) as amended,
any Subscriber entitled to FMLA leave may continue their benefits, and any Dependents’ benefits, under
the Plan as if continuously employed during the entire FMLA leave period. Certain limitations stated below
may apply. No new conditions or waiting periods will apply to the benefits upon Your return to work.
You may be entitled to FMLA leave for the following reasons:
Birth of a child, and to care for such child;
Placement of a child with You for adoption or foster care;
To care for Your seriously ill spouse, child, or parent;
A serious health condition that makes You unable to perform Your job functions.
The Employer shall be responsible for determination of Your eligibility, rights, or length of leave period for
FMLA for purposes of continuing Your benefits under the Plan.
Continuation of Coverage Due to Military Service
In the event You are no longer actively at work due to military service in the Armed Forces of the United
States, You may elect to continue health coverage for yourself and Your Dependents (if any) under the
Plan in accordance with the Uniformed Services Employment and Reemployment Rights Act of 1994, as
amended.
“Military service” means performance of duty on a voluntary or involuntary basis, and includes active duty,
active duty for training, initial active duty for training, inactive duty training, and full-time National Guard
duty.
You may elect to continue to cover yourself and Your eligible Dependents (if any) under the Plan by notifying
Your Employer in advance and payment of any required contribution for health coverage. This may include
the amount the Employer normally pays on Your behalf. If Your military service is for a period of time less
39
Are now eligible for coverage due to marriage, birth, adoption, or placement for adoption.
Important Notes About Special Enrollment:
Individuals enrolled during special enrollment periods are not Late Enrollees.
Individuals or Dependents must request coverage within 30 days of a qualifying event (i.e., marriage,
exhaustion of COBRA, etc.).
Medicaid and CHIP Special Enrollment/Special Enrollees
Eligible Employees and Dependents may also enroll under two additional circumstances:
the Employee’s or Dependent’s Medicaid or Children’s Health Insurance Program (CHIP) coverage is
terminated as a result of loss of eligibility; or
the Employee or Dependent becomes eligible for a subsidy (state premium assistance program).
The Employee or Dependent must request Special Enrollment within 60 days of the loss of Medicaid/CHIP
or of the eligibility determination.
Annual Open Enrollment Period
Eligible employees and/or family members who were not covered under this plan and who do not qualify
as special enrollees can enroll for coverage during the open enrollment period generally in November each
year. Coverage will be effective January 1 of the following year.
Family and Medical Leave Act
If the Employer is subject to the requirements of the Family and Medical Leave Act (FMLA) as amended,
any Subscriber entitled to FMLA leave may continue their benefits, and any Dependents’ benefits, under
the Plan as if continuously employed during the entire FMLA leave period. Certain limitations stated below
may apply. No new conditions or waiting periods will apply to the benefits upon Your return to work.
You may be entitled to FMLA leave for the following reasons:
Birth of a child, and to care for such child;
Placement of a child with You for adoption or foster care;
To care for Your seriously ill spouse, child, or parent;
A serious health condition that makes You unable to perform Your job functions.
The Employer shall be responsible for determination of Your eligibility, rights, or length of leave period for
FMLA for purposes of continuing Your benefits under the Plan.
Continuation of Coverage Due to Military Service
In the event You are no longer actively at work due to military service in the Armed Forces of the United
States, You may elect to continue health coverage for yourself and Your Dependents (if any) under the
Plan in accordance with the Uniformed Services Employment and Reemployment Rights Act of 1994, as
amended.
“Military service” means performance of duty on a voluntary or involuntary basis, and includes active duty,
active duty for training, initial active duty for training, inactive duty training, and full-time National Guard
duty.
You may elect to continue to cover yourself and Your eligible Dependents (if any) under the Plan by notifying
Your Employer in advance and payment of any required contribution for health coverage. This may include
the amount the Employer normally pays on Your behalf. If Your military service is for a period of time less
39
