Page 3 - Salus Group Plan Doc SPD

Table of Contents

Introduction ............................................................................................................................... 2
Plan Overview ........................................................................................................................... 7
Your Eligibility .......................................................................................................................... 7
Eligible Dependents ................................................................................................................. 7
When Coverage Begins ........................................................................................................... 8
Proof of Dependent Eligibility ................................................................................................... 8
Your Contribution for Coverage ............................................................................................... 8
Enrolling for Coverage ............................................................................................................. 9
New Hire Enrollment ............................................................................................................. 9
Late Entrant .......................................................................................................................... 9
Annual Open Enrollment Period ............................................................................................... 9
Effect of Section 125 Tax Regulations on this Plan .................................................................. 9
Special Enrollment Rights ...................................................................................................... 10
When Coverage Ends ............................................................................................................ 10
Cancellation of Coverage ....................................................................................................... 10
Rescission of Coverage ......................................................................................................... 11
Coverage While Not at Work .................................................................................................. 11
If You Take a Leave of Absence (FMLA) ............................................................................... 11
If You Take a Military Leave of Absence ................................................................................ 11
Your Health Care Coverage .................................................................................................... 12
Participation ........................................................................................................................... 12
Benefits Provided ................................................................................................................... 12
Source of Payments............................................................................................................... 13
Opt-Out Credits ...................................................................................................................... 13
Limitations and Exclusions ..................................................................................................... 13
Continuation of Health Care Coverage through COBRA ........................................................ 13
For More Information ............................................................................................................. 13
Your Life and Accidental Death & Dismemberment (“AD&D”) Coverage ........................... 14
Participation ........................................................................................................................... 14
Benefits Provided ................................................................................................................... 14
Source of Payment ................................................................................................................ 14
Plan Limitations and Exclusions ............................................................................................. 14
Coverage Continuation .......................................................................................................... 14
For More Information ............................................................................................................. 14
Your Disability Benefits .......................................................................................................... 15
Participation ........................................................................................................................... 15
Benefits Provided ................................................................................................................... 15
Source of Payment ................................................................................................................ 15
Payment of Benefits ............................................................................................................... 15
Offset of Other Benefits ......................................................................................................... 16
Limitations and Exclusions ..................................................................................................... 16
Claims and Appeals ............................................................................................................... 16
For More Information ............................................................................................................. 16
Your Voluntary Dental Plan Coverage ................................................................................... 17
Participation ........................................................................................................................... 17
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