Special Enrollment Rights

Most retirees and dependents who satisfy the eligibility requirements of this plan enroll directly in the plan as described above. However, a federal law, the Health Insurance Portability and Accountability Act of 1996 (HIPAA), allows certain individuals a special opportunity to enroll in the Retiree Health Plan if enrollment was initially declined. Special enrollment rights apply as described below if certain requirements are met.

Loss of Other Health Care Coverage

You or your dependents who are otherwise eligible for coverage but not enrolled may enroll for coverage if all of the following requirements are met:

• Enrollment in the Retiree Health Plan was declined because you or your dependents were covered under another group health plan, other health insurance coverage such as a Medicare Managed Care Plan, or Medicare Supplemental Insurance (Medigap), or COBRA Continuation Coverage when initially eligible to enroll in the Retiree Health Plan.
• When enrollment was declined, a Notice To Decline Coverage Agreement was completed which reserved enrollment rights for you or your dependents in this plan after loss of eligibility under the other group health plan, other health insurance coverage such as a Medicare Managed Care Plan, or Medicare Supplemental Insurance (Medigap) or COBRA Continuation Coverage.
• The other health care coverage terminated due to (1) loss of eligibility including loss due to legal separation, divorce, death, termination of employment or reduction in work hours; (2) termination of employer contributions; (3) if the other coverage was under a COBRA Continuation Coverage provision, the maximum coverage period was exhausted; or (4) disenrollment from a Medicare Managed Care Plan or Medicare Supplemental Insurance (Medigap). Loss of eligibility does not include a loss due to failure to pay premiums on a timely basis or termination of coverage for cause, such as making a fraudulent claim or an intentional misrepresentation of a material fact in connection with the plan.

To enroll, you must complete and submit to the Trust Office a Retiree Health Plan Application for you or your dependents no later than 60 days after your or your dependents' other health care coverage terminates. A certificate of prior coverage and a copy of the other plan's termination of coverage notice must be provided to the Trust Office with the application.

Coverage under the Retiree Health Plan is effective the first day of the month immediately following timely receipt of the completed application. If the completed application and required documentation is not received within 60 days, the right to enroll is forfeited.