Common use of Special Enrollment Clause in Contracts

Special Enrollment. Certain specified events provide You with the opportunity to enroll or disenroll yourself or eligible Dependents from coverage on this Contract. These are special enrollment events. Enrollment or disenrollment must be made during the Special Enrollment Period specified in this Contract. Members who lose this or other coverage because they do not pay their premium or required contributions or lose this or other coverage for cause (such as filing fraudulent Claims or an intentional misrepresentation of a material fact in connection with the Contract) are not special enrollees and have no special enrollment rights. Examples of special enrollment events for this Contract are: Loss of “minimum essential coverage” during the year as a consequence of: Loss of eligibility for coverage under another plan the individual was enrolled in as a result of death, divorce, or loss of dependent status under that health plan; Changing residence to an area not served by the health plan under which the individual was enrolled; Another dental plan stops offering benefits to a certain class of similarly situated individuals of which the individual was a member; Termination of employer contributions towards a person’s coverage under another dental plan in which the individual was enrolled; and Exhaustion of COBRA continuation coverage. An individual requesting special enrollment under this section because of loss of other minimal coverage must request enrollment under this Contract within sixty (60) days after the other coverage ends (or after the employer stops contributing toward the other coverage). If such enrollment is received by a Blue Cross and Blue Shield of Louisiana office within sixty (60) days after loss of other coverage, coverage will become effective on the date other coverage is lost. The request will be denied and coverage will not be available if Blue Cross and Blue Shield of Louisiana does not receive the request for enrollment form within sixty (60) days after the loss of other coverage. A Qualified Health Plan violates a material provision of its contract. The Subscriber gaining a Dependent or becoming a Dependent through marriage, birth, adoption, placement for adoption or mandate granting legal or provisional custody of the child or grandchild. The Special Enrollment Period described in this subparagraph is a period of sixty (60) days and shall begin on the later of the date Dependent coverage is made available or the date of the marriage, birth, adoption, legal placement for adoption, or mandate granting legal or provisional custody of a child or grandchild. Premiums may be adjusted for the additional coverage. Your request to enroll yourself or other persons because of these events must be received by Blue Cross and Blue Shield of Louisiana within sixty (60) days from the date of the event. If the request for enrollment is not made timely, the request will be denied. Your request to enroll Yourself or other eligible Dependents must be received by Blue Cross and Blue Shield of Louisiana within sixty (60) days from the date of the event. If the request for enrollment is not timely made, the request will be denied. “Minimum essential coverage” for Special Enrollment purposes under this section means those included under that term by Internal Revenue Code Section 5000A, as for example: Medicare.

Special Enrollment. Certain specified events provide You with Special Enrollment Periods exist outside of the opportunity Open Enrollment Period when the Eligible Person experiences a specific Special Enrollment event as described under this section. During these periods, application may be made to Company (for Off-Exchange coverage) or to SHOP (for On-Exchange coverage) to enroll or drop coverage or to enroll or disenroll yourself or eligible Dependents from coverage on this ContractDependents. These are special enrollment events. Enrollment or disenrollment must be made during the Special Enrollment Period specified in this Contract. Members Individuals who lose this or other coverage because they do did not pay their premium premiums or required contributions timely, or lose this or other coverage for cause (such as filing fraudulent Claims or an intentional misrepresentation of a material fact in connection with the Contract) plan), are not special enrollees Special Enrollees and have no special enrollment rights. An Eligible Person who is not enrolled under this Benefit Plan may be permitted to enroll as a Special Enrollee if each of the following conditions is met: If the Eligible Person was offered coverage under this Benefit Plan on a previous Open Enrollment, he must have declined enrollment in writing in a form established by Company for that purpose. Examples of special enrollment Special Enrollment events for this Contract are: Loss Enrollment or non-enrollment in this Benefit Plan was due to an error, misrepresentation or inaction of “minimum essential coverage” during an officer, employee or agent of the year as a consequence of: Loss SHOP or the United States Department of eligibility for coverage under another plan the individual was enrolled in as a result of death, divorceHealth and Human Services, or loss their instrumentalities. Company’s substantial violation of dependent status under that health plan; Changing residence to an area not served by the health plan under which the individual was enrolled; Another dental plan stops offering benefits to a certain class of similarly situated individuals of which the individual was a member; Termination of employer contributions towards a person’s coverage under another dental plan in which the individual was enrolled; and Exhaustion of COBRA continuation coverage. An individual requesting special enrollment under this section because of loss of other minimal coverage must request enrollment under this Contract within sixty (60) days after the other coverage ends (or after the employer stops contributing toward the other coverage). If such enrollment is received by a Blue Cross and Blue Shield of Louisiana office within sixty (60) days after loss of other coverage, coverage will become effective on the date other coverage is lost. The request will be denied and coverage will not be available if Blue Cross and Blue Shield of Louisiana does not receive the request for enrollment form within sixty (60) days after the loss of other coverage. A Qualified Health Plan violates a material provision of its contractthis Benefit Plan. Gaining access to new Qualified Health Plans because of a permanent move. Being an Indian, as defined in Section 4 of the Indian Health Care Improvement Act. Meeting other exceptional circumstances as determined by the SHOP. The Subscriber gaining a Dependent or becoming a Dependent gaining dependent status under another health plan through marriage, birth, adoption, placement for adoption or mandate granting legal or provisional custody custody. Premiums may be adjusted for the additional coverage if adding the new Dependent changes the class of coverage under the Benefit Plan. When the Subscriber gains dependent status under another plan, he may disenroll from this Benefit Plan outside of the child Open Enrollment Period. When the Subscriber gains a Dependent and because of that wishes to enroll himself, or grandchildenroll a Dependent in this Benefit Plan, the following rules apply: If not already participating, Eligible Employee may enroll with the Dependent if he has served any applicable Eligibility Waiting Period but has not enrolled during a previous enrollment period. In the case of the birth, adoption, or placement for adoption of a child, the Spouse of the employee may be enrolled as a Dependent if the Spouse is otherwise eligible for coverage. If the Group offers multiple health plan options, another option may be chosen by the Eligible Employee for himself and Dependents when special enrollee status applies. There may be a thirty (30) day period of automatic coverage for Newly Born Infants (natural born or adopted), as described below. Any period of automatic coverage runs concurrently with the Special Enrollment Period for adding these infants to this Benefit Plan. The Special Enrollment Period described in this subparagraph is a period of sixty (60) days and shall begin on the later of the date Dependent coverage is made available or the date of the marriage, birth, adoption, legal placement for adoption, or mandate granting legal or provisional custody of a child or grandchild. Premiums may be adjusted for the additional coverage. Your request to enroll yourself or other persons because of these events must be received by Blue Cross and Blue Shield of Louisiana within sixty (60) days from the date of the event. If the request for enrollment is not made timely, the request will be denied. Your request to enroll Yourself or other eligible Dependents must be received by Blue Cross and Blue Shield of Louisiana within sixty (60) days from the date of the event. If the request for enrollment is not timely made, the request will be denied. “Minimum essential coverage” for Special Enrollment purposes under this section means those included under that term by Internal Revenue Code Section 5000A, as for example: Medicare.no less than thirty

Special Enrollment. Certain specified events provide You with Special Enrollment Periods exist outside of the opportunity Open Enrollment Period when the Eligible Person experiences a specific Special Enrollment event as described under this section. During these periods, application may be made to Company (for Off-Exchange coverage) or to SHOP (for On-Exchange coverage) to enroll or drop coverage or to enroll or disenroll yourself or eligible Dependents from coverage on this ContractDependents. These are special enrollment events. Enrollment or disenrollment must be made during the Special Enrollment Period specified in this Contract. Members Individuals who lose this or other coverage because they do did not pay their premium premiums or required contributions timely, or lose this or other coverage for cause (such as filing fraudulent Claims or an intentional misrepresentation of a material fact in connection with the Contract) plan), are not special enrollees Special Enrollees and have no special enrollment rights. An Eligible Person who is not enrolled under this Benefit Plan may be permitted to enroll as a Special Enrollee if each of the following conditions is met: If the Eligible Person was offered coverage under this Benefit Plan on a previous Open Enrollment, he must have declined enrollment in writing in a form established by Company for that purpose. Examples of special enrollment Special Enrollment events for this Contract are: Loss Enrollment or non-enrollment in this Benefit Plan was due to an error, misrepresentation or inaction of “minimum essential coverage” during an officer, employee or agent of the year as a consequence of: Loss SHOP or the United States Department of eligibility for coverage under another plan the individual was enrolled in as a result of death, divorceHealth and Human Services, or loss their instrumentalities. Company’s substantial violation of dependent status under that health plan; Changing residence to an area not served by the health plan under which the individual was enrolled; Another dental plan stops offering benefits to a certain class of similarly situated individuals of which the individual was a member; Termination of employer contributions towards a person’s coverage under another dental plan in which the individual was enrolled; and Exhaustion of COBRA continuation coverage. An individual requesting special enrollment under this section because of loss of other minimal coverage must request enrollment under this Contract within sixty (60) days after the other coverage ends (or after the employer stops contributing toward the other coverage). If such enrollment is received by a Blue Cross and Blue Shield of Louisiana office within sixty (60) days after loss of other coverage, coverage will become effective on the date other coverage is lost. The request will be denied and coverage will not be available if Blue Cross and Blue Shield of Louisiana does not receive the request for enrollment form within sixty (60) days after the loss of other coverage. A Qualified Health Plan violates a material provision of its contractthis Benefit Plan. Gaining access to new Qualified Health Plans because of a permanent move. Being an Indian, as defined in Section 4 of the Indian Health Care Improvement Act. Meeting other exceptional circumstances as determined by the SHOP. The Subscriber gaining a Dependent or becoming a Dependent gaining dependent status under another health plan through marriage, birth, adoption, placement for adoption or mandate granting legal or provisional custody custody. Premiums may be adjusted for the additional coverage if adding the new Dependent changes the class of coverage under the Benefit Plan. When the Subscriber gains dependent status under another plan, he may disenroll from this Benefit Plan outside of the child Open Enrollment Period. When the Subscriber gains a Dependent and because of that wishes to enroll himself, or grandchildenroll a Dependent in this Benefit Plan, the following rules apply: If not already participating, Eligible Employee may enroll with the Dependent if he has served any applicable Eligibility Waiting Period but has not enrolled during a previous enrollment period. In the case of the birth, adoption, or placement for adoption of a child, the Spouse of the employee may be enrolled as a Dependent if the Spouse is otherwise eligible for coverage. If the Group offers multiple health plan options, another option may be chosen by the Eligible Employee for himself and Dependents when special enrollee status applies. There may be a thirty (30) day period of automatic coverage for Newly-Born Infants (natural born or adopted), as described below. Any period of automatic coverage runs concurrently with the Special Enrollment Period for adding these infants to this Benefit Plan. The Special Enrollment Period described in this subparagraph is a period of sixty (60) days and shall begin on the later of the date Dependent coverage is made available or the date of the marriage, birth, adoption, legal placement for adoption, or mandate granting legal or provisional custody of a child or grandchild. Premiums may be adjusted for the additional coverage. Your request to enroll yourself or other persons because of these events must be received by Blue Cross and Blue Shield of Louisiana within sixty (60) days from the date of the event. If the request for enrollment is not made timely, the request will be denied. Your request to enroll Yourself or other eligible Dependents must be received by Blue Cross and Blue Shield of Louisiana within sixty (60) days from the date of the event. If the request for enrollment is not timely made, the request will be denied. “Minimum essential coverage” for Special Enrollment purposes under this section means those included under that term by Internal Revenue Code Section 5000A, as for example: Medicare.no less than thirty

Special Enrollment. Certain specified events provide You with Special Enrollment Periods exist outside of the opportunity Open Enrollment Period when the Eligible Person experiences a specific Special Enrollment event as described under this section. During these periods, application may be made to Company (for Off-Exchange coverage) or to SHOP (for On-Exchange coverage) to enroll or drop coverage or to enroll or disenroll yourself or eligible Dependents from coverage on this ContractDependents. These are special enrollment events. Enrollment or disenrollment must be made during the Special Enrollment Period specified in this Contract. Members Individuals who lose this or other coverage because they do did not pay their premium premiums or required contributions timely, or lose this or other coverage for cause (such as filing fraudulent Claims or an intentional misrepresentation of a material fact in connection with the Contract) plan), are not special enrollees Special Enrollees and have no special enrollment rights. Examples of special enrollment events for An Eligible Person who is not enrolled under this Contract are: Loss of “minimum essential coverage” during the year Benefit Plan may be permitted to enroll as a consequence of: Loss Special Enrollee if each of eligibility the following conditions is met: 1. The Eligible Person must be eligible for coverage under another plan the individual terms of this Benefit Plan; and 2. If the Eligible Person was enrolled offered coverage under this Benefit Plan on a previous Open Enrollment, he must have declined enrollment in as writing in a result form established by Company for that purpose. Examples of deathSpecial Enrollment events are: 3. Enrollment or non-enrollment in this Benefit Plan was due to an error, divorcemisrepresentation or inaction of an officer, employee or agent of the SHOP or the United States Department of Health and Human Services, or loss their instrumentalities. 4. Company’s substantial violation of dependent status under that health plan; Changing residence to an area not served by the health plan under which the individual was enrolled; Another dental plan stops offering benefits to a certain class of similarly situated individuals of which the individual was a member; Termination of employer contributions towards a person’s coverage under another dental plan in which the individual was enrolled; and Exhaustion of COBRA continuation coverage. An individual requesting special enrollment under this section because of loss of other minimal coverage must request enrollment under this Contract within sixty (60) days after the other coverage ends (or after the employer stops contributing toward the other coverage). If such enrollment is received by a Blue Cross and Blue Shield of Louisiana office within sixty (60) days after loss of other coverage, coverage will become effective on the date other coverage is lost. The request will be denied and coverage will not be available if Blue Cross and Blue Shield of Louisiana does not receive the request for enrollment form within sixty (60) days after the loss of other coverage. A Qualified Health Plan violates a material provision of its contractthis Benefit Plan. 5. Gaining access to new Qualified Health Plans because of a permanent move. 6. Being an Indian, as defined in Section 4 of the Indian Health Care Improvement Act. 7. Meeting other exceptional circumstances as determined by the SHOP. 8. The Subscriber gaining a Dependent or becoming a Dependent gaining dependent status under another health plan through marriage, birth, adoption, placement for adoption or mandate granting legal or provisional custody custody. Premiums may be adjusted for the additional coverage if adding the new Dependent changes the class of coverage under the Benefit Plan. When the Subscriber gains dependent status under another plan, he may disenroll from this Benefit Plan outside of the child Open Enrollment Period. When the Subscriber gains a Dependent and because of that wishes to enroll himself, or grandchildenroll a Dependent in this Benefit Plan, the following rules apply: a. If not already participating, Eligible Employee may enroll with the Dependent if he has served any applicable Eligibility Waiting Period but has not enrolled during a previous enrollment period. In the case of the birth, adoption, or placement for adoption of a child, the Spouse of the employee may be enrolled as a Dependent if the Spouse is otherwise eligible for coverage. b. If the Group offers multiple health plan options, another option may be chosen by the Eligible Employee for himself and Dependents when special enrollee status applies. c. There may be a thirty (30) day period of automatic coverage for Newly-Born Infants (natural born or adopted), as described below. Any period of automatic coverage runs concurrently with the Special Enrollment Period for adding these infants to this Benefit Plan. d. The Special Enrollment Period described in this subparagraph is a period of sixty (60) days and shall begin on the later of the date Dependent coverage is made available or the date of the marriage, birth, adoption, legal placement for adoption, or mandate granting legal or provisional custody of a child or grandchild. Premiums may be adjusted for the additional coverage. Your request to enroll yourself or other persons because of these events must be received by Blue Cross and Blue Shield of Louisiana within sixty (60) days from the date of the event. If the request for enrollment is not made timely, the request will be denied. Your request to enroll Yourself or other eligible Dependents must be received by Blue Cross and Blue Shield of Louisiana within sixty (60) days from the date of the event. If the request for enrollment is not timely made, the request will be denied. “Minimum essential coverage” for Special Enrollment purposes under this section means those included under that term by Internal Revenue Code Section 5000A, as for example: Medicare.no less than thirty

Special Enrollment. Certain specified events provide You with Special Enrollment Periods exist outside of the opportunity Open Enrollment Period when the Eligible Person experiences a specific Special Enrollment event as described under this section. During these periods, application may be made to Company (for Off-Exchange coverage) or to SHOP (for On-Exchange coverage) to enroll or drop coverage or to enroll or disenroll yourself or eligible Dependents from coverage on this ContractDependents. These are special enrollment events. Enrollment or disenrollment must be made during the Special Enrollment Period specified in this Contract. Members Individuals who lose this or other coverage because they do did not pay their premium premiums or required contributions timely, or lose this or other coverage for cause (such as filing fraudulent Claims or an intentional misrepresentation of a material fact in connection with the Contract) plan), are not special enrollees Special Enrollees and have no special enrollment rights. Examples of special enrollment events for An Eligible Person who is not enrolled under this Contract are: Loss of “minimum essential coverage” during the year Benefit Plan may be permitted to enroll as a consequence ofSpecial Enrollee if each of the following conditions is met: Loss of eligibility The Eligible Person must be eligible for coverage under another plan the individual terms of this Benefit Plan; and If the Eligible Person was enrolled offered coverage under this Benefit Plan on a previous Open Enrollment, he must have declined enrollment in as writing in a result form established by Company for that purpose. Examples of deathSpecial Enrollment events are: Enrollment or non-enrollment in this Benefit Plan was due to an error, divorcemisrepresentation or inaction of an officer, employee or agent of the SHOP or the United States Department of Health and Human Services, or loss their instrumentalities. Company’s substantial violation of dependent status under that health plan; Changing residence to an area not served by the health plan under which the individual was enrolled; Another dental plan stops offering benefits to a certain class of similarly situated individuals of which the individual was a member; Termination of employer contributions towards a person’s coverage under another dental plan in which the individual was enrolled; and Exhaustion of COBRA continuation coverage. An individual requesting special enrollment under this section because of loss of other minimal coverage must request enrollment under this Contract within sixty (60) days after the other coverage ends (or after the employer stops contributing toward the other coverage). If such enrollment is received by a Blue Cross and Blue Shield of Louisiana office within sixty (60) days after loss of other coverage, coverage will become effective on the date other coverage is lost. The request will be denied and coverage will not be available if Blue Cross and Blue Shield of Louisiana does not receive the request for enrollment form within sixty (60) days after the loss of other coverage. A Qualified Health Plan violates a material provision of its contractthis Benefit Plan. Gaining access to new Qualified Health Plans because of a permanent move. Being an Indian, as defined in Section 4 of the Indian Health Care Improvement Act. Meeting other exceptional circumstances as determined by the SHOP. The Subscriber gaining a Dependent or becoming a Dependent gaining dependent status under another health plan through marriage, birth, adoption, placement for adoption or mandate granting legal or provisional custody custody. Premiums may be adjusted for the additional coverage if adding the new Dependent changes the class of coverage under the Benefit Plan. When the Subscriber gains dependent status under another plan, he may disenroll from this Benefit Plan outside of the child Open Enrollment Period. When the Subscriber gains a Dependent and because of that wishes to enroll himself, or grandchildenroll a Dependent in this Benefit Plan, the following rules apply: If not already participating, Eligible Employee may enroll with the Dependent if he has served any applicable Eligibility Waiting Period but has not enrolled during a previous enrollment period. In the case of the birth, adoption, or placement for adoption of a child, the Spouse of the employee may be enrolled as a Dependent if the Spouse is otherwise eligible for coverage. If the Group offers multiple health plan options, another option may be chosen by the Eligible Employee for himself and Dependents when special enrollee status applies. There may be a thirty (30) day period of automatic coverage for Newly-Born Infants (natural born or adopted), as described below. Any period of automatic coverage runs concurrently with the Special Enrollment Period for adding these infants to this Benefit Plan. The Special Enrollment Period described in this subparagraph is a period of sixty (60) days and shall begin on the later of the date Dependent coverage is made available or the date of the marriage, birth, adoption, legal placement for adoption, or mandate granting legal or provisional custody of a child or grandchild. Premiums may be adjusted for the additional coverage. Your request to enroll yourself or other persons because of these events must be received by Blue Cross and Blue Shield of Louisiana within sixty (60) days from the date of the event. If the request for enrollment is not made timely, the request will be denied. Your request to enroll Yourself or other eligible Dependents must be received by Blue Cross and Blue Shield of Louisiana within sixty (60) days from the date of the event. If the request for enrollment is not timely made, the request will be denied. “Minimum essential coverage” for Special Enrollment purposes under this section means those included under that term by Internal Revenue Code Section 5000A, as for example: Medicare.no less than thirty

Special Enrollment. Certain specified events provide You with Special Enrollment Periods exist outside of the opportunity Open Enrollment Period when the Eligible Person experiences a specific Special Enrollment event as described under this section. During these periods, application may be made to Company (for Off-Exchange coverage) or to SHOP (for On-Exchange coverage) to enroll or drop coverage or to enroll or disenroll yourself or eligible Dependents from coverage on this ContractDependents. These are special enrollment events. Enrollment or disenrollment must be made during the Special Enrollment Period specified in this Contract. Members Individuals who lose this or other coverage because they do did not pay their premium premiums or required contributions timely, or lose this or other coverage for cause (such as filing fraudulent Claims or an intentional misrepresentation of a material fact in connection with the Contract) plan), are not special enrollees Special Enrollees and have no special enrollment rights. Examples of special enrollment events for An Eligible Person who is not enrolled under this Contract are: Loss of “minimum essential coverage” during the year Benefit Plan may be permitted to enroll as a consequence ofSpecial Enrollee if each of the following conditions is met: Loss of eligibility The Eligible Person must be eligible for coverage under another plan the individual terms of this Benefit Plan; and If the Eligible Person was enrolled offered coverage under this Benefit Plan on a previous Open Enrollment, he must have declined enrollment in as writing in a result form established by Company for that purpose. Examples of deathSpecial Enrollment events are: Enrollment or non-enrollment in this Benefit Plan was due to an error, divorcemisrepresentation or inaction of an officer, employee or agent of the SHOP or the United States Department of Health and Human Services, or loss their instrumentalities. Company’s substantial violation of dependent status under that health plan; Changing residence to an area not served by the health plan under which the individual was enrolled; Another dental plan stops offering benefits to a certain class of similarly situated individuals of which the individual was a member; Termination of employer contributions towards a person’s coverage under another dental plan in which the individual was enrolled; and Exhaustion of COBRA continuation coverage. An individual requesting special enrollment under this section because of loss of other minimal coverage must request enrollment under this Contract within sixty (60) days after the other coverage ends (or after the employer stops contributing toward the other coverage). If such enrollment is received by a Blue Cross and Blue Shield of Louisiana office within sixty (60) days after loss of other coverage, coverage will become effective on the date other coverage is lost. The request will be denied and coverage will not be available if Blue Cross and Blue Shield of Louisiana does not receive the request for enrollment form within sixty (60) days after the loss of other coverage. A Qualified Health Plan violates a material provision of its contractthis Benefit Plan. Gaining access to new Qualified Health Plans because of a permanent move. Being an Indian, as defined in Section 4 of the Indian Health Care Improvement Act. Meeting other exceptional circumstances as determined by the SHOP. The Subscriber gaining a Dependent or becoming a Dependent gaining dependent status under another health plan through marriage, birth, adoption, placement for adoption or mandate granting legal or provisional custody custody. Premiums may be adjusted for the additional coverage if adding the new Dependent changes the class of coverage under the Benefit Plan. When the Subscriber gains dependent status under another plan, he may disenroll from this Benefit Plan outside of the child Open Enrollment Period. When the Subscriber gains a Dependent and because of that wishes to enroll himself, or grandchildenroll a Dependent in this Benefit Plan, the following rules apply: If not already participating, Eligible Employee may enroll with the Dependent if he has served any applicable Eligibility Waiting Period but has not enrolled during a previous enrollment period. In the case of the birth, adoption, or placement for adoption of a child, the Spouse of the employee may be enrolled as a Dependent if the Spouse is otherwise eligible for coverage. If the Group offers multiple health plan options, another option may be chosen by the Eligible Employee for himself and Dependents when special enrollee status applies. There may be a thirty (30) day period of automatic coverage for Newly Born Infants (natural born or adopted), as described below. Any period of automatic coverage runs concurrently with the Special Enrollment Period for adding these infants to this Benefit Plan. The Special Enrollment Period described in this subparagraph is a period of sixty (60) days and shall begin on the later of the date Dependent coverage is made available or the date of the marriage, birth, adoption, legal placement for adoption, or mandate granting legal or provisional custody of a child or grandchild. Premiums may be adjusted for the additional coverage. Your request to enroll yourself or other persons because of these events must be received by Blue Cross and Blue Shield of Louisiana within sixty (60) days from the date of the event. If the request for enrollment is not made timely, the request will be denied. Your request to enroll Yourself or other eligible Dependents must be received by Blue Cross and Blue Shield of Louisiana within sixty (60) days from the date of the event. If the request for enrollment is not timely made, the request will be denied. “Minimum essential coverage” for Special Enrollment purposes under this section means those included under that term by Internal Revenue Code Section 5000A, as for example: Medicare.no less than thirty

Special Enrollment. Certain specified events provide You with the opportunity to enroll or disenroll yourself or eligible Dependents from coverage on this Contract. These are special enrollment events. Enrollment or disenrollment must be made during the Special Enrollment Period specified in this Contract. Members who lose this or other coverage because they do not pay their premium or required contributions or lose this or other coverage for cause (such as filing fraudulent Claims or an intentional misrepresentation of a material fact in connection with the Contract) are not special enrollees and have no special enrollment rights. Examples of special enrollment events for this Contract are: Loss of “minimum essential coverage” coverage during the year as a consequence of: Loss of eligibility for coverage under another plan the individual was enrolled in as a result of death, divorce, or loss of dependent status under that health plan; Changing residence to an area not served by the health plan under which the individual was enrolled; Another dental plan stops offering benefits to a certain class of similarly situated individuals of which the individual was a member; Termination of employer contributions towards a person’s coverage under another dental plan in which the individual was enrolled; and Exhaustion of COBRA continuation coverage. An individual requesting special enrollment under this section because of loss of other minimal coverage must request enrollment under this Contract within sixty (60) days after the other coverage ends (or after the employer stops contributing toward the other coverage). If such enrollment is received by a Blue Cross and Blue Shield of Louisiana office within sixty (60) days after loss of other coverage, coverage will become effective on the date other coverage is lost. The request will be denied and coverage will not be available if Blue Cross and Blue Shield of Louisiana does not receive the request for enrollment form within sixty (60) days after the loss of other coverage. A Qualified Health Plan violates a material provision of its contract. The Subscriber gaining a Dependent or becoming a Dependent through marriage, birth, adoption, placement for adoption or mandate granting legal or provisional custody of the child or grandchild. The Special Enrollment Period described in this subparagraph is a period of sixty (60) days and shall begin on the later of the date Dependent coverage is made available or the date of the marriage, birth, adoption, legal placement for adoption, or mandate granting legal or provisional custody of a child or grandchild. Premiums may be adjusted for the additional coverage. Your request to enroll yourself or other persons because of these events must be received by Blue Cross and Blue Shield of Louisiana within sixty (60) days from the date of the event. If the request for enrollment is not made timely, the request will be denied. Your request to enroll Yourself or other eligible Dependents must be received by Blue Cross and Blue Shield of Louisiana within sixty (60) days from the date of the event. If the request for enrollment is not timely made, the request will be denied. “Minimum essential coverage” coverage for Special Enrollment purposes under this section means those included under that term by Internal Revenue Code Section 5000A, as for example: Medicare.

Special Enrollment. Certain specified events provide You with Special Enrollment Periods exist outside of the opportunity Open Enrollment Period when the Eligible Person experiences a specific Special Enrollment event as described under this section. During these periods, application may be made to Company (for Off-Exchange coverage) or to SHOP (for On-Exchange coverage) to enroll or drop coverage or to enroll or disenroll yourself or eligible Dependents from coverage on this ContractDependents. These are special enrollment events. Enrollment or disenrollment must be made during the Special Enrollment Period specified in this Contract. Members Individuals who lose this or other coverage because they do did not pay their premium premiums or required contributions timely, or lose this or other coverage for cause (such as filing fraudulent Claims or an intentional misrepresentation of a material fact in connection with the Contract) plan), are not special enrollees Special Enrollees and have no special enrollment rights. Examples of special enrollment events for An Eligible Person who is not enrolled under this Contract are: Loss of “minimum essential coverage” during the year Benefit Plan may be permitted to enroll as a consequence of: Loss Special Enrollee if each of eligibility the following conditions is met: 1. The Eligible Person must be eligible for coverage under another plan the individual terms of this Benefit Plan; and 2. If the Eligible Person was enrolled offered coverage under this Benefit Plan on a previous Open Enrollment, he must have declined enrollment in as writing in a result form established by Company for that purpose. 3. Examples of deathSpecial Enrollment events are: 4. Enrollment or non-enrollment in this Benefit Plan was due to an error, divorcemisrepresentation or inaction of an officer, employee or agent of the SHOP or the United States Department of Health and Human Services, or loss their instrumentalities. 5. Company’s substantial violation of dependent status under that health plan; Changing residence to an area not served by the health plan under which the individual was enrolled; Another dental plan stops offering benefits to a certain class of similarly situated individuals of which the individual was a member; Termination of employer contributions towards a person’s coverage under another dental plan in which the individual was enrolled; and Exhaustion of COBRA continuation coverage. An individual requesting special enrollment under this section because of loss of other minimal coverage must request enrollment under this Contract within sixty (60) days after the other coverage ends (or after the employer stops contributing toward the other coverage). If such enrollment is received by a Blue Cross and Blue Shield of Louisiana office within sixty (60) days after loss of other coverage, coverage will become effective on the date other coverage is lost. The request will be denied and coverage will not be available if Blue Cross and Blue Shield of Louisiana does not receive the request for enrollment form within sixty (60) days after the loss of other coverage. A Qualified Health Plan violates a material provision of its contractthis Benefit Plan. 6. Gaining access to new Qualified Health Plans because of a permanent move. 7. Being an Indian, as defined in Section 4 of the Indian Health Care Improvement Act. 8. Meeting other exceptional circumstances as determined by the SHOP. 9. The Subscriber gaining a Dependent or becoming a Dependent gaining dependent status under another health plan through marriage, birth, adoption, placement for adoption or mandate granting legal or provisional custody custody. Premiums may be adjusted for the additional coverage if adding the new Dependent changes the class of coverage under the Benefit Plan. When the Subscriber gains dependent status under another plan, he may disenroll from this Benefit Plan outside of the child Open Enrollment Period. When the Subscriber gains a Dependent and because of that wishes to enroll himself, or grandchildenroll a Dependent in this Benefit Plan, the following rules apply: a. If not already participating, Eligible Employee may enroll with the Dependent if he has served any applicable Eligibility Waiting Period but has not enrolled during a previous enrollment period. In the case of the birth, adoption, or placement for adoption of a child, the Spouse of the employee may be enrolled as a Dependent if the Spouse is otherwise eligible for coverage. b. If the Group offers multiple health plan options, another option may be chosen by the Eligible Employee for himself and Dependents when special enrollee status applies. c. There may be a thirty (30) day period of automatic coverage for Newly-Born Infants (natural born or adopted), as described below. Any period of automatic coverage runs concurrently with the Special Enrollment Period for adding these infants to this Benefit Plan. d. The Special Enrollment Period described in this subparagraph is a period of sixty (60) days and shall begin on the later of the date Dependent coverage is made available or the date of the marriage, birth, adoption, legal placement for adoption, or mandate granting legal or provisional custody of a child or grandchild. Premiums may be adjusted for the additional coverage. Your request to enroll yourself or other persons because of these events must be received by Blue Cross and Blue Shield of Louisiana within sixty (60) days from the date of the event. If the request for enrollment is not made timely, the request will be denied. Your request to enroll Yourself or other eligible Dependents must be received by Blue Cross and Blue Shield of Louisiana within sixty (60) days from the date of the event. If the request for enrollment is not timely made, the request will be denied. “Minimum essential coverage” for Special Enrollment purposes under this section means those included under that term by Internal Revenue Code Section 5000A, as for example: Medicare.no less than thirty

Special Enrollment. Certain specified events provide You with Special Enrollment Periods exist outside of the opportunity Open Enrollment Period when the Eligible Person experiences a specific Special Enrollment event as described under this section. During these periods, application may be made to Company (for Off-Exchange coverage) or to SHOP (for On-Exchange coverage) to enroll or drop coverage or to enroll or disenroll yourself or eligible Dependents from coverage on this ContractDependents. These are special enrollment events. Enrollment or disenrollment must be made during the Special Enrollment Period specified in this Contract. Members Individuals who lose this or other coverage because they do did not pay their premium premiums or required contributions timely, or lose this or other coverage for cause (such as filing fraudulent Claims or an intentional misrepresentation of a material fact in connection with the Contract) plan), are not special enrollees Special Enrollees and have no special enrollment rights. Examples of special enrollment events for An Eligible Person who is not enrolled under this Contract are: Loss of “minimum essential coverage” during the year Benefit Plan may be permitted to enroll as a consequence ofSpecial Enrollee if each of the following conditions is met: Loss of eligibility The Eligible Person must be eligible for coverage under another plan the individual terms of this Benefit Plan; and If the Eligible Person was enrolled offered coverage under this Benefit Plan on a previous Open Enrollment, he must have declined enrollment in as writing in a result form established by Company for that purpose. Examples of deathSpecial Enrollment events are: Enrollment or non-enrollment in this Benefit Plan was due to an error, divorcemisrepresentation or inaction of an officer, employee or agent of the SHOP or the United States Department of Health and Human Services, or loss their instrumentalities. Company’s substantial violation of dependent status under that health plan; Changing residence to an area not served by the health plan under which the individual was enrolled; Another dental plan stops offering benefits to a certain class of similarly situated individuals of which the individual was a member; Termination of employer contributions towards a person’s coverage under another dental plan in which the individual was enrolled; and Exhaustion of COBRA continuation coverage. An individual requesting special enrollment under this section because of loss of other minimal coverage must request enrollment under this Contract within sixty (60) days after the other coverage ends (or after the employer stops contributing toward the other coverage). If such enrollment is received by a Blue Cross and Blue Shield of Louisiana office within sixty (60) days after loss of other coverage, coverage will become effective on the date other coverage is lost. The request will be denied and coverage will not be available if Blue Cross and Blue Shield of Louisiana does not receive the request for enrollment form within sixty (60) days after the loss of other coverage. A Qualified Health Plan violates a material provision of its contractthis Benefit Plan. Gaining access to new Qualified Health Plans because of a permanent move. Being an Indian, as defined in Section 4 of the Indian Health Care Improvement Act. Meeting other exceptional circumstances as determined by the SHOP. The Subscriber gaining a Dependent or becoming a Dependent gaining dependent status under another health plan through marriage, birth, adoption, placement for adoption or mandate granting legal or provisional custody custody. Premiums may be adjusted for the additional coverage if adding the new Dependent changes the class of coverage under the Benefit Plan. When the Subscriber gains dependent status under another plan, he may disenroll from this Benefit Plan outside of the child Open Enrollment Period. When the Subscriber gains a Dependent and because of that wishes to enroll himself, or grandchildenroll a Dependent in this Benefit Plan, the following rules apply: If not already participating, Eligible Employee may enroll with the Dependent if he has served any applicable Eligibility Waiting Period but has not enrolled during a previous enrollment period. In the case of the birth, adoption, or placement for adoption of a child, the Spouse of the employee may be enrolled as a Dependent if the Spouse is otherwise eligible for coverage. If the Group offers multiple health plan options, another option may be chosen by the Eligible Employee for himself and Dependents when special enrollee status applies. There may be a thirty (30) day period of automatic coverage for Newly Born Infants (natural born or adopted), as described below. Any period of automatic coverage runs concurrently with the Special Enrollment Period for adding these infants to this Benefit Plan. The Special Enrollment Period described in this subparagraph is a period of sixty (60) days and shall begin on the later of the date Dependent coverage is made available or the date of the marriage, birth, adoption, legal placement for adoption, or mandate granting legal or provisional custody of a child or grandchild. Premiums may be adjusted for the additional coverage. Your request to enroll yourself or other persons because of these events must be received by Blue Cross and Blue Shield of Louisiana within sixty (60) days from the date of the event. If the request for enrollment is not made timely, the request will be denied. Your request to enroll Yourself or other eligible Dependents must be received by Blue Cross and Blue Shield of Louisiana within sixty (60) days from the date of the event. If the request for enrollment is not timely made, the request will be denied. “Minimum essential coverage” for Special Enrollment purposes under this section means those included under that term by Internal Revenue Code Section 5000A, as for example: Medicare.no less than thi rty

Special Enrollment. Certain specified events provide You with Special Enrollment Periodsexist outside ofthe Open Enrollment Period when the opportunity Eligible Person experiences a specific Special Enrollment event as described under this section. During these periods, application may be made to Company (for Off-Exchange coverage) or to SHOP (for On-Exchange coverage) to enroll or drop coverage or to enroll or disenroll yourself or eligible Dependents from coverage on this ContractDependents. These are special enrollment events. Enrollment or disenrollment must be made during the Special Enrollment Period specified in this Contract. Members Individuals who lose this or other coverage because they do did not pay their premium premiums or required contributions timely, or lose this or other coverage for cause (such as filing fraudulent Claims or an intentional misrepresentation of a material fact in connection with the Contract) plan), are not special enrollees Special Enrollees and have no special enrollment rights. Examples of special enrollment events for An Eligible Person who is not enrolled under this Contract are: Loss of “minimum essential coverage” during the year Benefit Plan may be permitted to enroll as a consequence of: Loss Special Enrollee if each of eligibility the following conditions is met: 1. The Eligible Person must be eligible for coverage under another plan the individual terms of this Benefit Plan; and 2. If the Eligible Person was enrolled offered coverage under this Benefit Plan on a previous Open Enrollment, he must have declined enrollment in as writing in a result form established by Company for that purpose. Examples of deathSpecial Enrollment events are: 3. Enrollment or non-enrollment in this Benefit Plan was due to an error, divorcemisrepresentation or inaction of an officer, employee or agent of the SHOP or the United States Department of Health and Human Services, or loss their instrumentalities. 4. Company’s substantial violation of dependent status under that health plan; Changing residence to an area not served by the health plan under which the individual was enrolled; Another dental plan stops offering benefits to a certain class of similarly situated individuals of which the individual was a member; Termination of employer contributions towards a person’s coverage under another dental plan in which the individual was enrolled; and Exhaustion of COBRA continuation coverage. An individual requesting special enrollment under this section because of loss of other minimal coverage must request enrollment under this Contract within sixty (60) days after the other coverage ends (or after the employer stops contributing toward the other coverage). If such enrollment is received by a Blue Cross and Blue Shield of Louisiana office within sixty (60) days after loss of other coverage, coverage will become effective on the date other coverage is lost. The request will be denied and coverage will not be available if Blue Cross and Blue Shield of Louisiana does not receive the request for enrollment form within sixty (60) days after the loss of other coverage. A Qualified Health Plan violates a material provision of its contractthis Benefit Plan. 5. Gaining access to new Qualified Health Plans because of a permanent move. 6. Being an Indian, as defined in Section 4 of the Indian Health Care Improvement Act. 7. Meeting other exceptional circumstances as determined by the SHOP. 8. The Subscriber gaining a Dependent or becoming a Dependent gaining dependent status under another health plan through marriage, birth, adoption, placement for adoption or mandate granting legal or provisional custody custody. Premiums may be adjusted for the additional coverage if adding the new Dependent changes the class of coverage under the Benefit Plan. When the Subscriber gains dependent status under another plan, he may disenroll from this Benefit Plan outside of the child Open Enrollment Period. When the Subscriber gains a Dependent and because of that wishes to enroll himself, or grandchildenroll a Dependent in this Benefit Plan, the following rules apply: a. If not already participating, Eligible Employee may enroll with the Dependent if he has served any applicable Eligibility Waiting Period but has not enrolled during a previous enrollment period. In the case of the birth, adoption, or placement for adoption of a child, the Spouse of the employee may be enrolled as a Dependent if the Spouse is otherwise eligible for coverage. b. If the Group offers multiple health plan options, another option may be chosen by the Eligible Employee for himself and Dependents when special enrollee status applies. c. There may be a thirty (30) day period of automatic coverage for Newly-Born Infants (natural born or adopted), as described below. Any period of automatic coverage runs concurrently with the Special Enrollment Period for adding these infants to this Benefit Plan. d. The Special Enrollment Period described in this subparagraph is a period of sixty (60) days and shall begin on the later of the date Dependent coverage is made available or the date of the marriage, birth, adoption, legal placement for adoption, or mandate granting legal or provisional custody of a child or grandchild. Premiums may be adjusted for the additional coverage. Your request to enroll yourself or other persons because of these events must be received by Blue Cross and Blue Shield of Louisiana within sixty (60) days from the date of the event. If the request for enrollment is not made timely, the request will be denied. Your request to enroll Yourself or other eligible Dependents must be received by Blue Cross and Blue Shield of Louisiana within sixty (60) days from the date of the event. If the request for enrollment is not timely made, the request will be denied. “Minimum essential coverage” for Special Enrollment purposes under this section means those included under that term by Internal Revenue Code Section 5000A, as for example: Medicare.no less than thirty

Special Enrollment. Certain specified events provide You with the opportunity to enroll or disenroll yourself or eligible Dependents from coverage on this ContractContract outside of the Open Enrollment Period. These are special enrollment events. Enrollment or disenrollment must be made during the Special Enrollment Period specified in this Contract. Members who lose this or other coverage because they do not pay their premium or required contributions or lose this or other coverage for cause (such as filing fraudulent Claims or an intentional misrepresentation of a material fact in connection with the Contract) are not special enrollees and have no special enrollment rights. 1. Examples of special enrollment events for this Contract all Contracts purchased both On-Exchange and Off- Exchange are: : a. Loss of “minimum essential coverage” during the year as a consequence of: : (4) Loss of eligibility for coverage under another plan the individual was enrolled in as a result of death, divorce, or loss of dependent status under that health plan; Changing residence to an area not served by the health plan under which the individual was enrolled; Another dental health plan stops offering benefits to a certain class of similarly situated individuals of which the individual was a member; Termination of employer contributions towards a person’s coverage under another dental health plan in which the individual was enrolled; and Exhaustion of COBRA continuation coverage. An individual requesting special enrollment under this section because of loss of other minimal coverage must request enrollment under this Contract within sixty (60) days after the other coverage ends (or after the employer stops contributing toward the other coverage). If such enrollment is received by a Blue Cross and Blue Shield of Louisiana office within sixty (60) days after loss of other coverage, coverage will become effective on the date other coverage is lost. The request will be denied and coverage will not be available if Blue Cross and Blue Shield of Louisiana does not receive the request for enrollment form within sixty (60) days after the loss of other coverage. A Qualified Health Plan violates a material provision of its contract. New determination of eligibility or ineligibility for the advanced payments of the premium tax credit or change in eligibility for cost-sharing reductions in the Exchange. The Subscriber gaining a Dependent or becoming a Dependent through marriage, birth, adoption, placement for adoption or mandate granting legal or provisional custody of the child or grandchild. The Special Enrollment Period described in this subparagraph is a period of sixty (60) days and shall begin on the later of the date Dependent coverage is made available or the date of the marriage, birth, adoption, legal placement for adoption, or mandate granting legal or provisional custody of a child or grandchild. Premiums may be adjusted for the additional coverage. Your request to enroll yourself or other persons because of these events must be received by Blue Cross and Blue Shield of Louisiana within sixty (60) days from the date of the event. If the request for enrollment is not made timely, the request will be denied. Examples of additional special enrollment events for Contracts purchased only on-Exchange are: Being an Indian, as defined in Section 4 of the Indian Healthcare Improvement Act; Gaining new status as a United States citizen, national, or other legal presence in the United States; and Enrollment or non-enrollment in a Qualified Health Plan was due to an error, misrepresentation or inaction of an officer, employee or agent of the Exchange or the United States Department of Health and Human Services, or their instrumentalities. Your request to enroll Yourself or other eligible Dependents must be received by Blue Cross and Blue Shield of Louisiana within sixty (60) days from the date of the event. If the request for enrollment is not timely made, the request will be denied. “Minimum essential coverage” for Special Enrollment purposes under this section means those included under that term by Internal Revenue Code Section 5000A, as for example: Medicare.

Special Enrollment. Certain specified events provide You with Special Enrollment Periods exist outside of the opportunity Open Enrollment Period when the Eligible Person experiences a specific Special Enrollment event as described under this section. During these periods, application may be made to Company (for Off-Exchange coverage) or to SHOP (for On-Exchange coverage) to enroll or drop coverage or to enroll or disenroll yourself or eligible Dependents from coverage on this ContractDependents. These are special enrollment events. Enrollment or disenrollment must be made during the Special Enrollment Period specified in this Contract. Members Individuals who lose this or other coverage because they do did not pay their premium premiums or required contributions timely, or lose this or other coverage for cause (such as filing fraudulent Claims or an intentional misrepresentation of a material fact in connection with the Contract) plan), are not special enrollees Special Enrollees and have no special enrollment rights. Examples of special enrollment events for An Eligible Person who is not enrolled under this Contract are: Loss of “minimum essential coverage” during the year Benefit Plan may be permitted to enroll as a consequence ofSpecial Enrollee if each of the following conditions is met: Loss of eligibility The Eligible Person must be eligible for coverage under another plan the individual terms of this Benefit Plan; and If the Eligible Person was enrolled offered coverage under this Benefit Plan on a previous Open Enrollment, he must have declined enrollment in as writing in a result form established by Company for that purpose. Examples of deathSpecial Enrollment events are: Enrollment or non-enrollment in this Benefit Plan was due to an error, divorcemisrepresentation or inaction of an officer, employee or agent of the SHOP or the United States Department of Health and Human Services, or loss their instrumentalities. Company’s substantial violation of dependent status under that health plan; Changing residence to an area not served by the health plan under which the individual was enrolled; Another dental plan stops offering benefits to a certain class of similarly situated individuals of which the individual was a member; Termination of employer contributions towards a person’s coverage under another dental plan in which the individual was enrolled; and Exhaustion of COBRA continuation coverage. An individual requesting special enrollment under this section because of loss of other minimal coverage must request enrollment under this Contract within sixty (60) days after the other coverage ends (or after the employer stops contributing toward the other coverage). If such enrollment is received by a Blue Cross and Blue Shield of Louisiana office within sixty (60) days after loss of other coverage, coverage will become effective on the date other coverage is lost. The request will be denied and coverage will not be available if Blue Cross and Blue Shield of Louisiana does not receive the request for enrollment form within sixty (60) days after the loss of other coverage. A Qualified Health Plan violates a material provision of its contractthis Benefit Plan. Gaining access to new Qualified Health Plans because of a permanent move. Being an Indian, as defined in Section 4 of the Indian Health Care Improvement Act. Meeting other exceptional circumstances as determined by the SHOP. The Subscriber gaining a Dependent or becoming a Dependent gaining dependent status under another health plan through marriage, birth, adoption, placement for adoption or mandate granting legal or provisional custody of the child or grandchild. The Special Enrollment Period described in this subparagraph is a period of sixty (60) days and shall begin on the later of the date Dependent coverage is made available or the date of the marriage, birth, adoption, legal placement for adoption, or mandate granting legal or provisional custody of a child or grandchildcustody. Premiums may be adjusted for the additional coveragecoverage if adding the new Dependent changes the class of coverage under the Benefit Plan. Your request When the Subscriber gains dependent status under another plan, he may disenroll from this Benefit Plan outside of the Open Enrollment Period. When the Subscriber gains a Dependent and because of that wishes to enroll yourself himself, or other persons because of these events must be received by Blue Cross and Blue Shield of Louisiana within sixty (60) days from the date of the event. If the request for enrollment is not made timelyenroll a Dependent in this Benefit Plan, the request will be denied. Your request to enroll Yourself or other eligible Dependents must be received by Blue Cross and Blue Shield of Louisiana within sixty (60) days from the date of the event. If the request for enrollment is not timely made, the request will be denied. “Minimum essential coverage” for Special Enrollment purposes under this section means those included under that term by Internal Revenue Code Section 5000A, as for example: Medicare.following rules apply:

Special Enrollment. Certain specified events provide You with the opportunity to enroll or disenroll yourself or eligible Dependents from coverage on this Contract. These are special enrollment events. Enrollment or disenrollment must be made during the Special Enrollment Period specified in this Contract. Members who lose this or other coverage because they do not pay their premium or required contributions or lose this or other coverage for cause (such as filing fraudulent Claims or an intentional misrepresentation of a material fact in connection with the Contract) are not special enrollees and have no special enrollment rights. Examples of special enrollment events for this Contract are: Loss of “minimum essential coverage” coverage during the year as a consequence of: Loss of eligibility for coverage under another plan the individual was enrolled in as a result of death, divorce, or loss of dependent status under that health plan; Changing residence to an area not served by the health plan under which the individual was enrolled; Another dental plan stops offering benefits to a certain class of similarly situated individuals of which the individual was a member; Termination of employer contributions towards a person’s coverage under another dental plan in which the individual was enrolled; and Exhaustion of COBRA continuation coverage. An individual requesting special enrollment under this section because of loss of other minimal coverage must request enrollment under this Contract within sixty (60) days after the other coverage ends (or after the employer stops contributing toward the other coverage). If such enrollment is received by a Blue Cross and Blue Shield of Louisiana office within sixty (60) days after loss of other coverage, coverage will become effective on the date other coverage is lost. The request will be denied and coverage will not be available if Blue Cross and Blue Shield of Louisiana does not receive the request for enrollment form within sixty (60) days after the loss of other coverage. A Qualified Health Plan violates a material provision of its contract. The Subscriber gaining a Dependent or becoming a Dependent through marriage, birth, adoptionadopt ion, placement for adoption or mandate granting legal or provisional custody of the child or grandchild. The Special Enrollment Period described in this subparagraph is a period of sixty (60) days and shall begin on the later of the date Dependent coverage is made available or the date of the marriage, birth, adoption, legal placement for adoption, or mandate granting legal or provisional custody of a child or grandchild. Premiums may be adjusted for the additional coverage. Your request to enroll yourself or other persons because of these events must be received by Blue Cross and Blue Shield of Louisiana within sixty (60) days from the date of the event. If the request for enrollment is not made timely, the request will be denied. Your request to enroll Yourself or other eligible Dependents must be received by Blue Cross and Blue Shield of Louisiana within sixty (60) days from the date of the event. If the request for enrollment is not timely made, the request will be denied. “Minimum essential coverage” coverage for Special Enrollment purposes under this section means those included under that term by Internal Revenue Code Section 5000A, as for example: Medicare.