Special Enrollment. Under the circumstances described below, referred to as “qualifying events”, eligible employees and/or eligible dependents may request to enroll in the Plan outside of the initial and annual open enrollment periods, during a special enrollment period.
Special Enrollment a. KFHPWA will allow special enrollment for persons:
Special Enrollment. If a Qualified Individual does not enroll during an Annual Open Enrollment Period, he or she may only enroll through the Exchange during a Special Enrollment Period. Except as otherwise provided, during a Special Enrollment Period, a Qualified Individual not currently enrolled in a QHP may enroll in any QHP. In addition, a Qualified Individual currently enrolled a QHP may enroll in another QHP within the same metal level of coverage, or one metal level higher or lower if the same metal level of coverage is not available. A Dependent of a Qualified Individual currently enrolled in a QHP may be added to the Qualified Individual’s current QHP, may enroll with the Qualified Individual in another QHP within the same level of coverage (or one metal level higher or lower if no such QHP is available), or may enroll in any separate QHP. These limitations do not apply to Section 2.6B.1.(i) (plan enrollment for Indians), Section 2.6B.1.(d) (Exchange errors or non-Exchange errors), Section 2.6B.1.(j) (exceptional circumstances), Section 2.6B.1.(m) (victim of domestic violence). For Qualified Individuals using a Special Enrollment Period pursuant to Section 2.6B.1.(i) (plan enrollment for Indians), Section 2.6B.1.(d) (Exchange errors or non-Exchange errors), Section 2.6B.1.(j) (exceptional circumstances), Section 2.6B.1.(m) (victim of domestic violence), the Qualified Individual or the Dependent of a Qualified Individual may enroll in or change to any QHP regardless of whether the Qualified Individual or Dependent of a Qualified Individual is currently enrolled in a QHP.
Special Enrollment. If a Qualified Individual does not enroll during an Annual Open Enrollment Period, he or she may only enroll through the Exchange during a Special Enrollment Period.
Special Enrollment. Special Enrollment Periods exist outside of the 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 Dependents. Individuals who lose other coverage because they did not pay their premiums or required contributions timely, or lose other coverage for cause (such as filing fraudulent Claims or an intentional misrepresentation of a material fact in connection with the plan), are not 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: The Eligible Person must be eligible for coverage under the terms of this Benefit Plan; and 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 events are: Enrollment or non-enrollment in this Benefit Plan was due to an error, misrepresentation or inaction of an officer, employee or agent of the SHOP or the United States Department of Health and Human Services, or their instrumentalities. Company’s substantial violation of a material provision of this 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 gaining dependent status under another health plan through marriage, birth, adoption, placement for adoption or mandate granting legal or provisional 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 Open Enrollment Period. When the Subscriber gains a Dependent and because of that wishes to enroll himself, or enroll 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 enroll...
Special Enrollment. If you do not enroll when you are first eligible and later want to enroll, you can enroll only during Open Enrollment as described below, unless one of the following is true:
Special Enrollment. During the year, if you have certain qualifying life-changing events, you and your Dependents can enroll for coverage under the Plan through “Special Enrollment.” Special qualifying events, such as birth or adoption of a child, marriage, loss of other qualified health insurance coverage, or changes in eligibility for other public service programs, will trigger a Special Enrollment Period. For guidance on qualifying events, contact the Marketplace or Community Health Options’ Member Services. To take advantage of a Special Enrollment Period, you must complete the enrollment process by visiting the Marketplace to complete information about a change in circumstances or by visiting xxx.xxxxxxxxxxxxx.xxx to complete a “Special Enrollment Period Qualifying Event” web form. If you do not have access to the internet, you may also submit a completed paper Application to Health Options or the Marketplace, as applicable. You must complete the enrollment process for new Dependent coverage within 60 days of the qualifying event. If you become a Member or add new Dependents through a Special Enrollment Period, the effective date of coverage depends on the type and date of event, as well as when Community Health Options® (“Health Options”) receives premium payment and the completed enrollment information. You will be notified of the effective date of coverage.
Special Enrollment. Under the circumstances described below, an Eligible Employee or Eligible Dependent may request to enroll in the Plan outside of the annual open enrollment period.
Special Enrollment. Outside of the annual open enrollment period, certain “triggering events” allow a Contractholder’s eligible dependents, or an eligible individual on behalf of himself and his eligible dependents, to enroll in the Plan during a special enrollment period (SEP). In order for coverage to become effective, any application or enrollment forms we require, along with proof of the triggering event (e.g. certificate of marriage, written evidence of adoption or copy of a court order), must be submitted to us within the timeframes described below. If not received within the required timeframes, coverage will not become effective, and enrollment will not be available until the next annual open enrollment period.
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.
