Special Enrollments Clause Samples

Special Enrollments. (a) Notwithstanding any provision to the contrary, an Eligible Individual or an eligible Dependent of an Eligible Individual may elect health care coverage under Special Enrollment, but only if (1) the Eligible Individual (or the eligible Dependent) was covered under a group health plan or health insurance at the time coverage was offered under this Plan; (2) the Eligible Individual (or the eligible Dependent) declined coverage under the Plan in writing for the stated reason that he had the other health coverage; (3) the Eligible Individual (or the eligible Dependent) has "Exhausted COBRA Coverage" or the other health coverage (or the individual's former employer's contribution toward the cost of such coverage) has terminated; and (4) the Eligible Individual (or the eligible Dependent) requests Special Enrollment under this Section in writing within thirty (30) days after the date he or she lost his or her other health coverage.

Special Enrollments. (1) Special enrollment due to newly eligible dependents. (a) A person may enroll as a Subscriber (along with any or all eligible Family Dependents), and existing Subscribers may add any or all eligible Family Dependents, within 31 calendar days after marriage or civil union, birth, adoption, or placement for adoption by submitting a change of enrollment form to Group and Group submitting the completed enrollment form to Health Plan within 31 calendar days after a Family Dependent become newly eligible. (b) Effective date of an enrollment resulting from marriage or civil union is no later than the first day of the month following the date Group receives an enrollment form from the Subscriber. Enrollments due to birth, adoption, or placement for adoption are effective on the date of birth, adoption, or placement for adoption. (2) Special Enrollment due to loss of other coverage. (a) A person may enroll as a Subscriber (along with any or all eligible Family Dependents), and existing Subscribers may add any or all eligible Family Dependents, by submitting an enrollment form to Group and Group submitting the completed enrollment form to Health Plan within 31 calendar days after such person loses other coverage if: (i) Subscriber or at least one of the Family Dependents had other coverage when he or she previously declined coverage, and (ii) The loss of other coverage is due to one of the following: x exhaustion of COBRA coverage x termination of employer contributions for non- COBRA coverage x loss of eligibility for non-COBRA coverage, but not termination for cause from a Kaiser Permanente health plan for reasons specified in section 9-C(1) or termination from Kaiser Permanente for Individuals and Families (nongroup) plan for nonpayment x loss of eligibility for Medicaid coverage or CHIP coverage, but not termination for cause, x loss of eligibility for coverage under any other health insurance , public assistance or prepaid health plan described in HRS §393-17, or x reaching a lifetime maximum on all benefits. (b) A person requesting enrollment resulting from loss of Medicaid cover or CHIP coverage must submit an enrollment form to Group and Group must submit the completed enrollment form to Health Plan within 60 calendar days after such person loses Medicaid or CHIP coverage, (c) Effective date of an enrollment resulting from loss of other coverage is no later than the first day of the month following the date that Group receives an enrollment or change of e...