Page 3 - KCCU Health & Welfare SPD

Table of Contents

Introduction .............................................................................................................................. 2

Table of Contents ..................................................................................................................... 3
Plan Overview .......................................................................................................................... 6
Your Eligibility ......................................................................................................................... 6
Eligible Dependents ................................................................................................................ 6
When Coverage Begins .......................................................................................................... 7
Proof of Dependent Eligibility .................................................................................................. 7
Your Contribution for Coverage ............................................................................................... 7
Enrolling for Coverage ............................................................................................................ 8
New Hire Enrollment ............................................................................................................ 8
Late Entrant ......................................................................................................................... 8
Annual Open Enrollment Period .............................................................................................. 8
Effect of Section 125 Tax Regulations on this Plan ................................................................. 8
Special Enrollment Rights ....................................................................................................... 9
When Coverage Ends ............................................................................................................. 9
Cancellation of Coverage .......................................................................................................10
Rescission of Coverage .........................................................................................................10
Coverage While Not at Work ..................................................................................................10
If You Take a Leave of Absence (FMLA) ................................................................................10
If You Take a Military Leave of Absence ................................................................................. 11
Health Coverage after You Retire ...........................................................................................12
Qualification Requirements for Post-Retirement Coverage .................................................12
Coverage for Your Spouse ..................................................................................................12
Cost of Coverage ................................................................................................................12
Termination of Your Coverage .............................................................................................12
Your Death after Retirement ...............................................................................................13
Termination of Spouse Coverage ........................................................................................13
Death before Your Retirement ............................................................................................13
Coverage after Normal Retirement Age for Medicare Eligibility ...........................................13
Relation to COBRA Continuation Coverage ........................................................................13
Deferment of Coverage at Retirement ................................................................................14
Amendment and Termination ..............................................................................................14

Your Health Care Coverage ....................................................................................................15
Participation ...........................................................................................................................15
Benefits Provided ...................................................................................................................15
Source of Payments ...............................................................................................................16
Opt-Out Credits ......................................................................................................................16
Limitations and Exclusions .....................................................................................................16
Continuation of Health Care Coverage through COBRA ........................................................16
For More Information .............................................................................................................16
Your Life and Accidental Death & Dismemberment (“AD&D”) Coverage ............................17

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