Common use of Permitted Election Changes Clause in Contracts

Permitted Election Changes. For purposes of Section 4.2.C of this Plan, a Participant may revoke an election under this Plan during the Plan Year for which the election was intended to be made, and prospectively make a new election for the remainder of the Plan Year, under the following circumstances: A. HIPAA Special Enrollment Rights. A Participant may change an election under the Plan if the Participant or his or her Spouse or Dependent is entitled to special enrollment rights under a group health plan (other than an excepted benefit), as required by HIPAA under Code § 9801(f), permitting the Participant to revoke a prior election for group health plan coverage and to make a new election (including, when required by HIPAA, an election to enroll in another benefit package under a group health plan), provided that the election change under this Plan corresponds with such HIPAA special enrollment rights. As required by HIPAA, a special enrollment right will arise in the following circumstances: 1. A Participant or his or her Spouse or Dependent declined to enroll in group health plan coverage because he or she had coverage, and eligibility for such coverage is subsequently lost because: (i) the coverage was provided under COBRA and the COBRA coverage was exhausted; or (ii) the coverage was non-COBRA coverage and the coverage terminated due to loss of eligibility for coverage or the employer contributions for the coverage were terminated; 2. A new Dependent is acquired as a result of marriage, birth, adoption, or placement for adoption; 3. The Participant’s or Dependent’s coverage under a Medicaid plan or state children’s health insurance program is terminated as a result of loss of eligibility for such coverage; or 4. The Participant or Dependent becomes eligible for a state premium assistance subsidy from a Medicaid plan or through a state children’s health insurance program (SCHIP) with respect to coverage under the group health plan. An election to add previously eligible Dependents as a result of the acquisition of a new Spouse or Dependent child shall be considered to be consistent with the special enrollment right. An election change on account of a HIPAA special enrollment attributable to the birth, adoption, or placement for adoption of a new Dependent child may, subject to the provisions of the underlying group health plan, be effective retroactively (up to 30 days). For purposes of this sub-section, the term “loss of eligibility” includes (but is not limited to) loss of eligibility due to legal separation, divorce, cessation of dependent status, death of an employee, termination of employment, reduction of hours, or any loss of eligibility for coverage that is measured with reference to any of the foregoing; loss of coverage offered through an HMO that does not provide benefits to individuals who do not reside, live, or work in the service area because an individual no longer resides, lives, or works in the service area (whether or not within the choice of the individual), and in the case of HMO coverage in the group market, no other benefit package is available to the individual; a situation in which an individual incurs a claim that would meet or exceed a lifetime limit on all benefits; and a situation in which a plan no longer offers any benefits to the class of similarly situated individuals that includes the individual.