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25C - AGMT GROUP INSURANCE
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25C - AGMT GROUP INSURANCE
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Last modified
2/1/2018 7:02:12 PM
Creation date
2/1/2018 7:10:52 PM
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City Clerk
Doc Type
Agenda Packet
Agency
Personnel Services
Item #
25C
Date
2/6/2018
Destruction Year
2023
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Your dependent may continue coverage under this plan for up to thirty-six (36) months if Your dependent's <br />dental benefits would otherwise end because of: <br />1. Your divorce, <br />2. Your legal separation, <br />3. Your death or <br />4. Your becoming eligible for Medicare. <br />Also, Your dependent child may continue coverage under this plan for up to thirty-six (36) months if such <br />child's benefits would otherwise end because that child no longer qualifies as a dependent under the terms of <br />this plan. <br />New Dependents <br />During the continuation period, a child of Yours that is: <br />1. born; <br />2. adopted by You; or <br />3. placed with You for adoption; <br />will be treated as if the child were a dependent at the time benefits were lost due to an event described <br />above. To obtain benefits for the child, You must enroll the child for coverage within thirty (30) days of birth, <br />adoption or placement for adoption. <br />Termination of Coverage <br />With respect to each person who continues benefits, the continued benefits will end on the earliest of: <br />1. the end of the thirty-six (36) month continuation period; <br />2. the date of expiration of the last period for which the required payment was made; <br />3. the date this plan or coverage for Your class is cancelled; <br />4. the date the person becomes entitled to Medicare; <br />5. the date the person becomes covered by another group benefit plan that does not have an exclusion or <br />limitation for preexisting conditions that applies to the person; <br />6. the date the person becomes covered or could become covered by Federal Cobra (Section 4980B of the <br />United States Internal Revenue Code); <br />7. the date the person becomes covered or could become covered under a plan governed by Chapter 6A of <br />the Public Health Service Act, 42 U.S.C. Section 300bb-1 at seq., relating to Requirements for Certain <br />Group Health Plans for Certain State and Local Employees; <br />8. The first day of the first month that begins more than thirty-one (31) days after the date of final <br />determination under Title I or Title XVI of the Social Security Act that the person is no longer disabled. <br />Notice and Election of Coverage <br />When You or Your dependents become entitled to continue benefits under the plan because of. <br />1. Your termination or <br />2. Your reduction of hours worked, <br />We will send You, at Your last known address, the necessary Prepayment Fee information and enrollment <br />forms and disclosures within fourteen (14) days. You or Your dependents, will then have sixty (60) days to <br />elect to continue benefits from the latest of: <br />1. the date of the event that gives a right to continue coverage; <br />GCERT2011-DHMO-EOC 25C-30 16 <br />
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