Page 18 - Allegacy 2019 Benefit Guide Full Time

DOL Required Notices

Special Enrollment Rights

If you are declining enrollment for yourself or your dependents (including your spouse) because of other health
insurance 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 another employer stops contributing toward your or your dependents’
other coverage). Should you choose to do this, you must request enrollment within 31 days* after your or your
dependents’ other coverage ends (or after the other employer stops contributing toward the coverage). 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. Should you choose to do this, you must request enrollment within 31 days
after the marriage, birth, adoption, or placement for adoption.

COBRA Continuation Coverage

A federal law known as The Consolidated Omnibus Reconciliation Act (COBRA) requires that most employers
sponsoring group healthcare plans offer employees and their families the opportunity for a temporary extension of
healthcare coverage (called continuation coverage) at group rates in certain instances where coverage under the
terms of the plan would otherwise end. This notice is intended to inform you of your rights and obligations under
the continuation coverage provisions of the law.

If you are an employee of Allegacy and are covered by its group healthcare plan, you have a right to choose this
continuation coverage if you lose your group healthcare coverage under the terms of the plan because of a
reduction in your hours of employment or the termination of your employment (for reasons other than gross
misconduct on your part). If you are the spouse of an employee and are covered by the group healthcare plan, you
have the right to choose this continuation coverage if you lose your group healthcare coverage under the terms of
the healthcare plan for any of the following reasons:

 The death of your spouse.
 A termination of your spouse’s employment (for reasons other than gross misconduct) or reduction in
your spouse’s hours of employment.
 Divorce or legal separation from your spouse.
 Your spouse becomes entitled to Medicare.

In the case of dependent children of an employee covered by the group healthcare plan, they have the right to
continuation coverage if group healthcare coverage under the terms of the healthcare plan is lost for any of the
following reasons:
 The death of a parent.
 A termination of a parent’s employment (for reasons other than gross misconduct) or reduction in a
parent’s hours of employment.
 Parent’s divorce or legal separation.
 A parent becomes entitled to Medicare.
 The dependent ceases to be a dependent child under the terms of the health plan.

Individuals described above who are entitled to COBRA continuation coverage are called qualified beneficiaries. If a
child is born to a covered employee or if a child is, before age 18, adopted by or placed for adoption with a covered
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