Page 9 - 2015 Four Seasons Non-Medical Enrollment Guide
P. 9
2015 Open Enrollment
Losing Other Coverage
If you waived coverage for yourself or for an eligible
dependent because other health coverage (including
COBRA coverage, Medicare, or Medicaid) was in
effect, you may add coverage under the Four Seasons
Medical Plan in certain circumstances, including, but
not limited to the following:
z Employer contributions for that coverage are
terminated
z You lose eligibility for that coverage for reasons
including termination of employment, reduction
in work hours, legal separation or divorce, death,
or change in dependent eligibility
z You were enrolled in HMO coverage and lose
beneits as a result of no longer living or working
in the HMO’s service area and no other beneit
package is available to you
z You incur a claim that would meet or exceed the lifetime limit on all You must request enrollment
beneits under the other plan within 30 days after the date the
z The plan no longer offers any beneits to the class of individuals of other coverage ends (or employer
which you or your spouse or domestic partner is a part contributions terminate). The
new election will be effective going
Loss of eligibility for other coverage does not include a loss due to the forward from the date you enroll.
failure to pay premiums on a timely basis or termination of coverage for
cause, such as fraud. Voluntary loss of coverage is not considered a qualiied If you do not enroll within 30
life event. days, you generally will not be
permitted to enroll until the next
If you waived coverage under the Four Seasons Medical Plan, and you annual enrollment period, or a
involuntarily lose your other coverage, you may enroll yourself and your different change in status event,
eligible dependents in any beneit option. If you are already enrolled in if earlier.
the Four Seasons Medical Plan, you may enroll your dependent in your
current option or you may change your election and enroll yourself and your
dependent in a different option.
9
Losing Other Coverage
If you waived coverage for yourself or for an eligible
dependent because other health coverage (including
COBRA coverage, Medicare, or Medicaid) was in
effect, you may add coverage under the Four Seasons
Medical Plan in certain circumstances, including, but
not limited to the following:
z Employer contributions for that coverage are
terminated
z You lose eligibility for that coverage for reasons
including termination of employment, reduction
in work hours, legal separation or divorce, death,
or change in dependent eligibility
z You were enrolled in HMO coverage and lose
beneits as a result of no longer living or working
in the HMO’s service area and no other beneit
package is available to you
z You incur a claim that would meet or exceed the lifetime limit on all You must request enrollment
beneits under the other plan within 30 days after the date the
z The plan no longer offers any beneits to the class of individuals of other coverage ends (or employer
which you or your spouse or domestic partner is a part contributions terminate). The
new election will be effective going
Loss of eligibility for other coverage does not include a loss due to the forward from the date you enroll.
failure to pay premiums on a timely basis or termination of coverage for
cause, such as fraud. Voluntary loss of coverage is not considered a qualiied If you do not enroll within 30
life event. days, you generally will not be
permitted to enroll until the next
If you waived coverage under the Four Seasons Medical Plan, and you annual enrollment period, or a
involuntarily lose your other coverage, you may enroll yourself and your different change in status event,
eligible dependents in any beneit option. If you are already enrolled in if earlier.
the Four Seasons Medical Plan, you may enroll your dependent in your
current option or you may change your election and enroll yourself and your
dependent in a different option.
9
