Common use of Eligibility and Enrollment Clause in Contracts

Eligibility and Enrollment. To enroll and continue enrollment, a Subscriber must be an eligible Employee and meet all of the eligibil- ity requirements for coverage established by the Em- ployer. An Employee who resides or works in the Plan Service area is eligible for coverage as a Sub- xxxxxxx the day following the date he or she com- pletes the waiting period established by the Em- ployer. The Employee’s spouse or Domestic Partner and all Dependent children who reside or work in the Plan Service Area are eligible for coverage at the same time. (Special arrangements may be available for Dependents who are full-time students; Depen- dents of Subscribers who are required by court order to provide coverage; and Dependents and Sub- scribers who are long-term travelers. Please contact the Member Services Department to request an Away From Home Care (AFHC) Program Brochure which explains these arrangements including how long AFHC coverage is available. This brochure is also available at xxxxx://xxx.xxxxxxxxxxxx.xxx for HMO Members). An Employee or the Employee’s Dependents may enroll when initially eligible or during the Em- ployer’s annual Open Enrollment Period. Under cer- tain circumstances, an Employee and Dependents may qualify for a Special Enrollment Period. Other than the initial opportunity to enroll, a date 12 months from the date a written request for enrollment is made, the Employer’s annual Open Enrollment pe- riod, or a Special Enrollment Period, an Employee or Dependent may not enroll in the health program of- fered by the Employer. Please see the definition of Late Enrollee and Special Enrollment Period in the Definitions section for details on these rights. For ad- ditional information on enrollment periods, please contact the Employer or Blue Shield. Dependent children of the Subscriber, spouse, or his or her Domestic Partner, including children adopted or placed for adoption, will be covered immediately after birth, adoption or the placement of adoption for a period of 31 days. In order to have coverage con- tinue beyond the first 31 days, an application must be received by Blue Shield within 31 days from the date of birth, adoption or placement for adoption. If both partners in a marriage or Domestic Partnership are eligible Employees and Subscribers, children may be eligible and may be enrolled as a Dependent of either parent, but not both. Please contact Blue Shield to xx- xxxxxxx what evidence needs to be provided to enroll a child. Enrolled disabled Dependent children who would normally lose their eligibility under this health plan solely because of age, may be eligible for coverage if they continue to meet the definition of Dependent. The Employer must meet specified Employer eligi- bility, participation and contribution requirements to be eligible for this group health plan. If the Employer fails to meet these requirements, this coverage will terminate. See the Termination of Benefits section of this EOC for further information. Employees will re- of the month following the date the request for special enrollment is received. ceive notice of this termination and, at that time, will be provided with information about other potential sources of coverage, including access to individual coverage through Covered California. Subject to the requirements described under the Con- tinuation of Group Coverage provision in this EOC, if applicable, an Employee and his or her Dependents will be eligible to continue group coverage under this health plan when coverage would otherwise termi- nate. Effective Date of Coverage Blue Shield will notify the eligible Employee/Sub- xxxxxxx of the effective date of coverage for the Em- Premiums (Dues) The monthly Premiums for a Subscriber and any en- rolled Dependents are stated in the Contract. Blue Shield will provide the Employer with information regarding when the Premiums are due and when pay- ments must be made for coverage to remain in effect. All Premiums required for coverage for the Sub- xxxxxxx and Dependents will be paid by the Employer to Blue Shield. Any amount the Subscriber must con- tribute is set by the Employer. The Employer will re- ceive notice of changes in Premiums at least 60 days prior to the change. The Employer will notify the Subscriber immediately. ployee and his or her Dependents. Coverage starts at

Eligibility and Enrollment. To enroll and continue enrollment, a Subscriber must be an eligible Employee and meet all of the eligibil- ity eligibility requirements for coverage established by the Em- ployerEmployer. An Employee who resides or works in the Plan Service area is eligible for coverage cov- erage as a Sub- xxxxxxx Subscriber the day following the date he or she com- pletes completes the waiting period established by the Em- ployerEmployer. The Employee’s spouse or Domestic Domes- tic Partner and all Dependent children who reside or work in the Plan Service Area are eligible for coverage at the same time. (Special arrangements may be available for Dependents who are full-time students; Depen- dents of Subscribers who are required by court order to provide coverage; and Dependents and Sub- scribers who are long-term travelers. Please contact the Member Services Department to request an Away From Home Care (AFHC) Program Brochure which explains these arrangements including how long AFHC coverage is available. This brochure is also available at xxxxx://xxx.xxxxxxxxxxxx.xxx for HMO Members). An Employee or the Employee’s Dependents may enroll when initially eligible or during the Em- ployer’s annual Open Enrollment Period. Under cer- tain certain circumstances, an Employee and Dependents Depen- dents may qualify for a Special Enrollment Period. Other than the initial opportunity to enroll, a date 12 months from the date a written request for enrollment en- rollment is made, the Employer’s annual Open Enrollment pe- riodEn- rollment period, or a Special Enrollment Period, an Employee or Dependent may not enroll in the health program of- fered offered by the Employer. Please see the definition of Late Enrollee and Special Enrollment En- rollment Period in the Definitions section for details de- tails on these rights. For ad- ditional additional information on enrollment periods, please contact the Employer or Blue Shield. Dependent children of the Subscriber, spouse, or his or her Domestic Partner, including children adopted or placed for adoption, will be covered immediately im- mediately after birth, adoption or the placement of adoption for a period of 31 days. In order to have coverage con- tinue continue beyond the first 31 days, an application ap- plication must be received by Blue Shield within 31 days from the date of birth, adoption or placement place- ment for adoption. If both partners in a marriage or Domestic Partnership are eligible Employees and Subscribers, children may be eligible and may be enrolled as a Dependent of either parent, but not both. Please contact Blue Shield to xx- xxxxxxx determine what evidence needs to be provided to enroll a child. Enrolled disabled Dependent children who would normally lose their eligibility under this health plan Health Plan solely because of age, may be eligible for coverage cov- erage if they continue to meet the definition of DependentDe- pendent. See the Definitions section. The Employer must meet specified Employer eligi- bilityxxx- gibility, participation and contribution requirements require- ments to be eligible for this group health planHealth Plan. If the Employer fails to meet these requirements, this coverage will terminate. See the Termination of Benefits section of this EOC for further informationinforma- tion. Employees will re- of the month following the date the request for special enrollment is received. ceive receive notice of this termination termi- nation and, at that time, will be provided with information in- formation about other potential sources of coveragecover- age, including access to individual coverage through Covered California. Subject to the requirements described under the Con- tinuation Continuation of Group Coverage provision in this EOC, if applicable, an Employee and his or her Dependents will be eligible to continue group coverage cov- erage under this health plan Health Plan when coverage would otherwise termi- nateterminate. Effective Date of Coverage Blue Shield will notify the eligible Employee/Sub- xxxxxxx of the effective date of coverage for the Em- Premiums (Dues) The monthly Premiums for a Subscriber and any en- rolled Dependents are stated in the Contract. Blue Shield will provide the Employer with information regarding when the Premiums are due and when pay- ments must be made for coverage to remain in effect. All Premiums required for coverage for the Sub- xxxxxxx and Dependents will be paid by the Employer to Blue Shield. Any amount the Subscriber must con- tribute is set by the Employer. The Employer will re- ceive notice of changes in Premiums at least 60 days prior to the change. The Employer will notify the Subscriber immediately. ployee Employee and his or her Dependents. Coverage starts atat 12:01 a.m. Pacific Time on the effective date. Dependents may be enrolled within 31 days of the Employee’s eligibility date to have the same effec- tive date of coverage as the Employee. If the Em- ployee or Dependent is considered a Late Enrollee, coverage will become effective the earlier of 12 months from the date a written request for cover- age is made or at the Employer’s next Open En- rollment Period. Blue Shield will not consider ap- plications for earlier effective dates unless the Em- ployee or Dependent qualifies for a Special Enroll- ment Period. In general, if the Employee or Dependents qualify for a Special Enrollment Period, and the premium payment is delivered or postmarked within the first 15 days of the month, coverage will be effective on the first day of the month after receipt of payment. If the premium payment is delivered or post- marked after the 15th of the month, coverage will be effective on the first day of the second month after receipt of payment. However, if the Employee qualifies for a Special Enrollment Period as a result of a birth, adoption, guardianship, marriage or Domestic Partnership and enrollment is requested by the Employee within 31 days of the event, the effective date of enrollment will be as follows:

Eligibility and Enrollment. To enroll and continue enrollment, a Subscriber must be an eligible Employee and meet all of the eligibil- ity eligibility requirements for coverage established by the Em- ployerEmployer. An Employee who resides or works in the Plan Service area is eligible for coverage cov- erage as a Sub- xxxxxxx Subscriber the day following the date he or she com- pletes completes the waiting period established by the Em- ployerEmployer. The Employee’s spouse or Domestic Domes- tic Partner and all Dependent children who reside or work in the Plan Service Area are eligible for coverage at the same time. (Special arrangements may be available for Dependents who are full-time students; Depen- dents of Subscribers who are required by court order to provide coverage; and Dependents and Sub- scribers who are long-term travelers. Please contact the Member Services Department to request an Away From Home Care (AFHC) Program Brochure which explains these arrangements including how long AFHC coverage is available. This brochure is also available at xxxxx://xxx.xxxxxxxxxxxx.xxx for HMO Members). An Employee or the Employee’s Dependents may enroll when initially eligible or during the Em- ployer’s annual Open Enrollment Period. Under cer- tain certain circumstances, an Employee and Dependents Depen- dents may qualify for a Special Enrollment Period. Other than the initial opportunity to enroll, a date 12 months from the date a written request for enrollment en- rollment is made, the Employer’s annual Open Enrollment pe- riodEn- rollment period, or a Special Enrollment Period, an Employee or Dependent may not enroll in the health program of- fered offered by the Employer. Please see the definition of Late Enrollee and Special Enrollment En- rollment Period in the Definitions section for details de- tails on these rights. For ad- ditional additional information on enrollment periods, please contact the Employer or Blue Shield. Dependent children of the Subscriber, spouse, or his or her Domestic Partner, including children adopted or placed for adoption, will be covered immediately im- mediately after birth, adoption or the placement of adoption for a period of 31 days. In order to have coverage con- tinue continue beyond the first 31 days, an application ap- plication must be received by Blue Shield within 31 days from the date of birth, adoption or placement place- ment for adoption. If both partners in a marriage or Domestic Partnership are eligible Employees and Subscribers, children may be eligible and may be enrolled as a Dependent of either parent, but not both. Please contact Blue Shield to xx- xxxxxxx determine what evidence needs to be provided to enroll a child. Enrolled disabled Dependent children who would normally lose their eligibility under this health plan Health Plan solely because of age, may be eligible for coverage cov- erage if they continue to meet the definition of DependentDe- pendent. See the Definitions section. The Employer must meet specified Employer eligi- bilityxxx- gibility, participation and contribution requirements require- ments to be eligible for this group health planHealth Plan. If the Employer fails to meet these requirements, this coverage will terminate. See the Termination of Benefits section of this EOC for further informationinforma- tion. Employees will re- of the month following the date the request for special enrollment is received. ceive receive notice of this termination termi- nation and, at that time, will be provided with information in- formation about other potential sources of coveragecover- age, including access to individual coverage through Covered California. Subject to the requirements described under the Con- tinuation Continuation of Group Coverage provision in this EOC, if applicable, an Employee and his or her Dependents will be eligible to continue group coverage cov- erage under this health plan Health Plan when coverage would otherwise termi- nateterminate. Effective Date of Coverage Blue Shield will notify the eligible Employee/Sub- xxxxxxx of the effective date of coverage for the Employee and his or her Dependents. Coverage starts at 12:01 a.m. Pacific Time on the effective date. Dependents may be enrolled within 31 days of the Employee’s eligibility date to have the same effec- tive date of coverage as the Employee. If the Em- Premiums (Dues) The monthly Premiums ployee or Dependent is considered a Late Enrollee, coverage will become effective the earlier of 12 months from the date a written request for a Subscriber and any en- rolled Dependents are stated in cover- age is made or at the ContractEmployer’s next Open En- rollment Period. Blue Shield will provide the Employer with information regarding when the Premiums are due and when pay- ments must be made for coverage to remain in effect. not consider ap- All Premiums required for coverage for the Sub- xxxxxxx and Dependents will be paid by the Employer Em- ployer to Blue Shield. Any amount the Subscriber must con- tribute is set by the Employer. The Employer will re- ceive receive notice of changes in Premiums at least 60 days prior to the change. The Employer will notify the Subscriber immediately. ployee and his or her Dependents. Coverage starts at.

Eligibility and Enrollment. To enroll and continue enrollment, a Subscriber must be an eligible Employee and meet all of the eligibil- ity eligibility requirements for coverage established by the Em- ployerEmployer. An Employee who resides or works in the Plan Service area is eligible for coverage cov- erage as a Sub- xxxxxxx Subscriber the day following the date he or she com- pletes completes the waiting period established by the Em- ployerEmployer. The Employee’s spouse or Domestic Domes- tic Partner and all Dependent children who reside or work in the Plan Service Area are eligible for coverage at the same time. (Special arrangements may be available for Dependents who are full-time students; Depen- dents of Subscribers who are required by court order to provide coverage; and Dependents and Sub- scribers who are long-term travelers. Please contact the Member Services Department to request an Away From Home Care (AFHC) Program Brochure which explains these arrangements including how long AFHC coverage is available. This brochure is also available at xxxxx://xxx.xxxxxxxxxxxx.xxx for HMO Members). An Employee or the Employee’s Dependents may enroll when initially eligible or during the Em- ployer’s annual Open Enrollment Period. Under cer- tain certain circumstances, an Employee and Dependents Depen- dents may qualify for a Special Enrollment Period. Other than the initial opportunity to enroll, a date 12 months from the date a written request for enrollment en- rollment is made, the Employer’s annual Open Enrollment pe- riodEn- rollment period, or a Special Enrollment Period, an Employee or Dependent may not enroll in the health program of- fered offered by the Employer. Please see the definition of Late Enrollee and Special Enrollment En- rollment Period in the Definitions section for details de- tails on these rights. For ad- ditional additional information on enrollment periods, please contact the Employer or Blue Shield. Dependent children of the Subscriber, spouse, or his or her Domestic Partner, including children adopted or placed for adoption, will be covered immediately eligible im- mediately after birth, adoption or the placement of adoption for a period of 31 days. In order to have coverage con- tinue continue beyond the first 31 days, an application ap- plication must be received by Blue Shield within 31 days from the date of birth, adoption or placement place- ment for adoption. If both partners in a marriage or Domestic Partnership are eligible Employees and Subscribers, children may be eligible and may be enrolled as a Dependent of either parent, but not both. Please contact Blue Shield to xx- xxxxxxx determine what evidence needs to be provided to enroll a child. Enrolled disabled Dependent children who would normally lose their eligibility under this health plan Health Plan solely because of age, may be eligible for coverage cov- erage if they continue to meet the definition of DependentDe- pendent. See the Definitions section. The Employer must meet specified Employer eligi- bilityxxx- gibility, participation and contribution requirements require- ments to be eligible for this group health planHealth Plan. If the Employer fails to meet these requirements, this coverage will terminate. See the Termination of Benefits section of this EOC for further informationinforma- tion. Employees will re- of the month following the date the request for special enrollment is received. ceive receive notice of this termination termi- nation and, at that time, will be provided with information in- formation about other potential sources of coveragecover- age, including access to individual coverage through Covered California. Subject to the requirements described under the Con- tinuation Continuation of Group Coverage provision in this EOC, if applicable, an Employee and his or her Dependents will be eligible to continue group coverage under this health plan when coverage would otherwise termi- nate. cov- Effective Date of Coverage Blue Shield will notify the eligible Employee/Sub- xxxxxxx of the effective date of coverage for the Em- Premiums (Dues) The monthly Premiums for a Subscriber and any en- rolled Dependents are stated in the Contract. Blue Shield will provide the Employer with information regarding when the Premiums are due and when pay- ments must be made for coverage to remain in effect. All Premiums required for coverage for the Sub- xxxxxxx and Dependents will be paid by the Employer to Blue Shield. Any amount the Subscriber must con- tribute is set by the Employer. The Employer will re- ceive notice of changes in Premiums at least 60 days prior to the change. The Employer will notify the Subscriber immediately. ployee Employee and his or her Dependents. Coverage starts atat 12:01 a.m. Pacific Time on the effective date. Dependents may be enrolled within 31 days of the Employee’s eligibility date to have the same effec- tive date of coverage as the Employee. If the Em- ployee or Dependent is considered a Late Enrollee, coverage will become effective the earlier of 12 months from the date a written request for cover- age is made or at the Employer’s next Open En- rollment Period. Blue Shield will not consider ap- plications for earlier effective dates unless the Em- ployee or Dependent qualifies for a Special Enroll- ment Period. In general, if the Employee or Dependents qualify for a Special Enrollment Period, and the premium payment is delivered or postmarked within the first 15 days of the month, coverage will be effective on the first day of the month after receipt of payment. If the premium payment is delivered or post- marked after the 15th of the month, coverage will be effective on the first day of the second month after receipt of payment. However, if the Employee qualifies for a Special Enrollment Period as a result of a birth, adoption, guardianship, marriage or Domestic Partnership and enrollment is requested by the Employee within 31 days of the event, the effective date of enrollment will be as follows:

Eligibility and Enrollment. To enroll and continue enrollment, a Subscriber must be an eligible Employee and meet all of the eligibil- ity eligibility requirements for coverage established by the Em- ployerEmployer. An Employee who resides or works in the Plan Service area is eligible for coverage cov- erage as a Sub- xxxxxxx Subscriber the day following the date he or she com- pletes completes the waiting period established by the Em- ployerEmployer. The Employee’s spouse or Domestic Domes- tic Partner and all Dependent children who reside or work in the Plan Service Area are eligible for coverage at the same time. (Special arrangements may be available for Dependents who are full-time students; Depen- dents of Subscribers who are required by court order to provide coverage; and Dependents and Sub- scribers who are long-term travelers. Please contact the Member Services Department to request an Away From Home Care (AFHC) Program Brochure which explains these arrangements including how long AFHC coverage is available. This brochure is also available at xxxxx://xxx.xxxxxxxxxxxx.xxx for HMO Members). An Employee or the Employee’s Dependents may enroll when initially eligible or during the Em- ployer’s annual Open Enrollment Period. Under cer- tain certain circumstances, an Employee and Dependents Depen- dents may qualify for a Special Enrollment Period. Other than the initial opportunity to enroll, a date 12 months from the date a written request for enrollment en- rollment is made, the Employer’s annual Open Enrollment pe- riodEn- rollment period, or a Special Enrollment Period, an Employee or Dependent may not enroll in the health program of- fered offered by the Employer. Please see the definition of Late Enrollee and Special Enrollment En- rollment Period in the Definitions section for details de- tails on these rights. For ad- ditional additional information on enrollment periods, please contact the Employer or Blue Shield. Dependent children of the Subscriber, spouse, or his or her Domestic Partner, including children adopted or placed for adoption, will be covered immediately im- mediately after birth, adoption or the placement of adoption for a period of 31 days. In order to have coverage con- tinue continue beyond the first 31 days, an application ap- plication must be received by Blue Shield within 31 days from the date of birth, adoption or placement place- ment for adoption. If both partners in a marriage or Domestic Partnership are eligible Employees and Subscribers, children may be eligible and may be enrolled as a Dependent of either parent, but not both. Please contact Blue Shield to xx- xxxxxxx determine what evidence needs to be provided to enroll a child. Enrolled disabled Dependent children who would normally lose their eligibility under this health plan Health Plan solely because of age, may be eligible for coverage cov- erage if they continue to meet the definition of DependentDe- pendent. See the Definitions section. The Employer must meet specified Employer eligi- bilityxxx- gibility, participation and contribution requirements require- ments to be eligible for this group health planHealth Plan. If the Employer fails to meet these requirements, this coverage will terminate. See the Termination of Benefits section of this EOC for further informationinforma- tion. Employees will re- of the month following the date the request for special enrollment is received. ceive receive notice of this termination termi- nation and, at that time, will be provided with information in- formation about other potential sources of coveragecover- age, including access to individual coverage through Covered California. Subject to the requirements described under the Con- tinuation Continuation of Group Coverage provision in this EOC, if applicable, an Employee and his or her Dependents will be eligible to continue group coverage cov- erage under this health plan Health Plan when coverage would otherwise termi- nateterminate. Effective Date of Coverage Blue Shield will notify the eligible Employee/Sub- xxxxxxx of the effective date of coverage for the Em- Premiums (Dues) The monthly Premiums for a Subscriber and any en- rolled Dependents are stated in the Contract. Blue Shield will provide the Employer with information regarding when the Premiums are due and when pay- ments must be made for coverage to remain in effect. All Premiums required for coverage for the Sub- xxxxxxx and Dependents will be paid by the Employer to Blue Shield. Any amount the Subscriber must con- tribute is set by the Employer. The Employer will re- ceive notice of changes in Premiums at least 60 days prior to the change. The Employer will notify the Subscriber immediately. ployee Employee and his or her Dependents. Coverage starts atat 12:01 a.m. Pacific Time on the effective date. Dependents may be enrolled within 31 days of the Employee’s eligibility date to have the same effec- tive date of coverage as the Employee. If the Em- ployee or Dependent is considered a Late Enrollee, coverage will become effective the earlier of 12 months from the date a written request for cover- age is made or at the Employer’s next Open En- rollment Period. Blue Shield will not consider ap- plications for earlier effective dates unless the Em- ployee or Dependent qualifies for a Special Enroll- ment Period. In general, if the Employee or Dependents qualify for a Special Enrollment Period coverage will be- gin no later than the first day of the first calendar month after Blue Shield receives the request for special enrollment from the Employer. However, if the Employee qualifies for a Special Enrollment Period as a result of a birth, adoption, guardianship, marriage or Domestic Partnership and enrollment is requested by the Employee within 31 days of the event, the effective date of enrollment will be as follows:

Eligibility and Enrollment. To enroll and continue enrollment, a Subscriber must be an eligible Employee and meet all of the eligibil- ity eligibility requirements for coverage established by the Em- ployerEmployer. An Employee who resides or works in the Plan Service area is eligible for coverage cov- erage as a Sub- xxxxxxx Subscriber the day following the date he or she com- pletes completes the waiting period established by the Em- ployerEmployer. The Employee’s spouse or Domestic Domes- tic Partner and all Dependent children who reside or work in the Plan Service Area are eligible for coverage at the same time. (Special arrangements may be available for Dependents who are full-time students; Depen- dents of Subscribers who are required by court order to provide coverage; and Dependents and Sub- scribers who are long-term travelers. Please contact the Member Services Department to request an Away From Home Care (AFHC) Program Brochure which explains these arrangements including how long AFHC coverage is available. This brochure is also available at xxxxx://xxx.xxxxxxxxxxxx.xxx for HMO Members). An Employee or the Employee’s Dependents may enroll when initially eligible or during the Em- ployer’s annual Open Enrollment Period. Under cer- tain certain circumstances, an Employee and Dependents Depen- dents may qualify for a Special Enrollment Period. Other than the initial opportunity to enroll, a date 12 months from the date a written request for enrollment en- rollment is made, the Employer’s annual Open Enrollment pe- riodEn- rollment period, or a Special Enrollment Period, an Employee or Dependent may not enroll in the health program of- fered offered by the Employer. Please see the definition of Late Enrollee and Special Enrollment En- rollment Period in the Definitions section for details de- tails on these rights. For ad- ditional additional information on enrollment periods, please contact the Employer or Blue Shield. Dependent children of the Subscriber, spouse, or his or her Domestic Partner, including children adopted or placed for adoption, will be covered immediately im- mediately after birth, adoption or the placement of adoption for a period of 31 days. In order to have coverage con- tinue continue beyond the first 31 days, an application ap- plication must be received by Blue Shield within 31 days from the date of birth, adoption or placement place- ment for adoption. If both partners in a marriage or Domestic Partnership are eligible Employees and Subscribers, children may be eligible and may be enrolled as a Dependent of either parent, but not both. Please contact Blue Shield to xx- xxxxxxx determine what evidence needs to be provided to enroll a child. Enrolled disabled Dependent children who would normally lose their eligibility under this health plan Health Plan solely because of age, may be eligible for coverage cov- erage if they continue to meet the definition of DependentDe- pendent. See the Definitions section. The Employer must meet specified Employer eligi- bilityxxx- gibility, participation and contribution requirements require- ments to be eligible for this group health planHealth Plan. If the Employer fails to meet these requirements, this coverage will terminate. See the Termination of Benefits section of this EOC for further informationinforma- tion. Employees will re- of the month following the date the request for special enrollment is received. ceive receive notice of this termination termi- nation and, at that time, will be provided with information in- formation about other potential sources of coveragecover- age, including access to individual coverage through Covered California. Subject to the requirements described under the Con- tinuation Continuation of Group Coverage provision in this EOC, if applicable, an Employee and his or her Dependents will be eligible to continue group coverage cov- erage under this health plan Health Plan when coverage would otherwise termi- nateterminate. Effective Date of Coverage Blue Shield will notify the eligible Employee/Sub- xxxxxxx of the effective date of coverage for the Em- Premiums (Dues) The monthly Premiums for a Subscriber and any en- rolled Dependents are stated in the Contract. Blue Shield will provide the Employer with information regarding when the Premiums are due and when pay- ments must be made for coverage to remain in effect. All Premiums required for coverage for the Sub- xxxxxxx and Dependents will be paid by the Employer to Blue Shield. Any amount the Subscriber must con- tribute is set by the Employer. The Employer will re- ceive notice of changes in Premiums at least 60 days prior to the change. The Employer will notify the Subscriber immediately. ployee Employee and his or her Dependents. Coverage starts atat 12:01 a.m. Pacific Time on the effective date. Dependents may be enrolled within 31 days of the Employee’s eligibility date to have the same effec- tive date of coverage as the Employee. If the Em- ployee or Dependent is considered a Late Enrollee, coverage will become effective the earlier of 12 months from the date a written request for cover- age is made or at the Employer’s next Open En- rollment Period. Blue Shield will not consider ap- plications for earlier effective dates unless the Em- ployee or Dependent qualifies for a Special Enroll- ment Period. In general, if the Employee or Dependents qualify for a Special Enrollment Period coverage will be- gin no later than the first day of the first calendar month after Blue Shield receives the request for special enrollment from the Employer. However, if the Employee qualifies for a Special Enrollment Period as a result of a birth, adoption, guardianship, marriage or Domestic Partnership and enrollment is requested by the Employee Out-of-Pocket Maximum amounts, are subject to change at any time. Blue Shield will provide at least 60 days written notice of any such change. Benefits for services or supplies furnished on or af- ter the effective date of any change in Benefits will be provided based on the change. within 31 days of the event, the effective date of enrollment will be as follows:

Eligibility and Enrollment. To enroll and continue enrollment, a Subscriber must be an eligible Employee and meet all of the eligibil- ity eligibility requirements for coverage established by the Em- ployerEmployer. An Employee who resides or works in the Plan Service area is eligible for coverage cov- erage as a Sub- xxxxxxx Subscriber the day following the date he or she com- pletes completes the waiting period established by the Em- ployerEmployer. The Employee’s spouse or Domestic Domes- tic Partner and all Dependent children who reside or work in the Plan Service Area are eligible for coverage at the same time. (Special arrangements may be available for Dependents who are full-time students; Depen- dents of Subscribers who are required by court order to provide coverage; and Dependents and Sub- scribers who are long-term travelers. Please contact the Member Services Department to request an Away From Home Care (AFHC) Program Brochure which explains these arrangements including how long AFHC coverage is available. This brochure is also available at xxxxx://xxx.xxxxxxxxxxxx.xxx for HMO Members). An Employee or the Employee’s Dependents may enroll when initially eligible or during the Em- ployer’s annual Open Enrollment Period. Under cer- tain certain circumstances, an Employee and Dependents Depen- dents may qualify for a Special Enrollment Period. Other than the initial opportunity to enroll, a date Subject to the requirements described under the Continuation of Group Coverage provision in this EOC, if applicable, an Employee and his or her Dependents will be eligible to continue group cov- erage under this Health Plan when coverage would otherwise terminate. 12 months from the date a written request for enrollment en- rollment is made, the Employer’s annual Open Enrollment pe- riodEn- rollment period, or a Special Enrollment Period, an Employee or Dependent may not enroll in the health program of- fered offered by the Employer. Please see the definition of Late Enrollee and Special Enrollment En- rollment Period in the Definitions section for details de- tails on these rights. For ad- ditional additional information on enrollment periods, please contact the Employer or Blue Shield. Dependent children of the Subscriber, spouse, or his or her Domestic Partner, including children adopted or placed for adoption, will be covered immediately eligible im- mediately after birth, adoption or the placement of adoption for a period of 31 days. In order to have coverage con- tinue continue beyond the first 31 days, an application ap- plication must be received by Blue Shield within 31 days from the date of birth, adoption or placement place- ment for adoption. If both partners in a marriage or Domestic Partnership are eligible Employees and Subscribers, children may be eligible and may be enrolled as a Dependent of either parent, but not both. Please contact Blue Shield to xx- xxxxxxx determine what evidence needs to be provided to enroll a child. Enrolled disabled Dependent children who would normally lose their eligibility under this health plan Health Plan solely because of age, may be eligible for coverage cov- erage if they continue to meet the definition of DependentDe- pendent. See the Definitions section. The Employer must meet specified Employer eligi- bilityxxx- gibility, participation and contribution requirements require- ments to be eligible for this group health planHealth Plan. If the Employer fails to meet these requirements, this coverage will terminate. See the Termination of Benefits section of this EOC for further informationinforma- tion. Employees will re- of the month following the date the request for special enrollment is received. ceive receive notice of this termination termi- nation and, at that time, will be provided with information in- formation about other potential sources of coveragecover- age, including access to individual coverage through Covered California. Subject to the requirements described under the Con- tinuation of Group Coverage provision in this EOC, if applicable, an Employee and his or her Dependents will be eligible to continue group coverage under this health plan when coverage would otherwise termi- nate. Effective Date of Coverage Blue Shield will notify the eligible Employee/Sub- xxxxxxx of the effective date of coverage for the Em- Premiums (Dues) The monthly Premiums for a Subscriber and any en- rolled Dependents are stated in the Contract. Blue Shield will provide the Employer with information regarding when the Premiums are due and when pay- ments must be made for coverage to remain in effect. All Premiums required for coverage for the Sub- xxxxxxx and Dependents will be paid by the Employer to Blue Shield. Any amount the Subscriber must con- tribute is set by the Employer. The Employer will re- ceive notice of changes in Premiums at least 60 days prior to the change. The Employer will notify the Subscriber immediately. ployee Employee and his or her Dependents. Coverage starts atat 12:01 a.m. Pacific Time on the effective date. Dependents may be enrolled within 31 days of the Employee’s eligibility date to have the same effec- tive date of coverage as the Employee. If the Em- ployee or Dependent is considered a Late Enrollee, coverage will become effective the earlier of 12 months from the date a written request for cover- age is made or at the Employer’s next Open En- rollment Period. Blue Shield will not consider ap- plications for earlier effective dates unless the Em- ployee or Dependent qualifies for a Special Enroll- ment Period. In general, if the Employee or Dependents qualify for a Special Enrollment Period, and the premium payment is delivered or postmarked within the first 15 days of the month, coverage will be effective on the first day of the month after receipt of payment. If the premium payment is delivered or post- marked after the 15th of the month, coverage will be effective on the first day of the second month after receipt of payment. However, if the Employee qualifies for a Special Enrollment Period as a result of a birth, adoption, guardianship, marriage or Domestic Partnership and enrollment is requested by the Employee within 31 days of the event, the effective date of enrollment will be as follows: