IT IS UNDERSTOOD AND AGREED THAT THE FOLLOWING MODIFICATION SHALL BE MADE:
In the INITIAL REQUIREMENTS section of the Plan document, the PARTICIPANT ENROLLMENT subsection will be revised to read as follows:
PARTICIPANT ENROLLMENT
Participant Coverage begins on the first date on which the person meets both of the following requirements:
A. The person is eligible for Participant Coverage.
B. The person has made written application for Participant Coverage on a form acceptable to the Plan Administrator.
If application for Participant Coverage is made after the first date on which coverage could begin, but within 30 days after that date, coverage will be retroactive to the first date on which coverage could have begun.
If application for Participant Coverage is not made within 30 days after the date coverage could have begun, the applicant must wait until the Annual Open Enrollment Period unless the applicant has special enrollment rights to enroll during a Special Enrollment Period or the applicant is permitted by the Employer to request a mid-year prospective enrollment as described in IRS Notice 2020-29 (see below for additional details). An applicant has special enrollment rights to enroll during a Special Enrollment Period in the following circumstances:
A. The applicant declined coverage when initially eligible or during a subsequent Annual Open Enrollment Period because the applicant had coverage under another group health plan or health insurance coverage, and that other coverage was subsequently lost for one of the following reasons:
- The other coverage was COBRA, and it has been exhausted.
- The applicant became ineligible (i.e., as a result of a Change in Status).
- Employer contributions for the coverage have been terminated.
- The other coverage was an HMO, and the individual no longer lives or works in the service area of the HMO (whether or not by choice of the individual).
- The other coverage no longer offers any benefits to a class of similarly situated individuals (e.g., part-time employees).
- A benefit package option is terminated (unless the individual is provided a current right to enroll in alternative health coverage).
- A plan’s lifetime limit on all benefits was applied.
Proof that the other coverage was lost must be provided to the Plan Administrator upon request.
An individual who lost other coverage on account of nonpayment of the required contribution or for cause (e.g., filing fraudulent claims) shall not have special enrollment rights to enroll during a Special Enrollment Period. An individual who voluntarily terminates other coverage shall not be considered to have special enrollment rights.
B. The applicant has acquired a new Dependent by marriage, birth, adoption, or placement for adoption. In this situation, special enrollment rights are available to the Employee, the Employee’s spouse, and any child who became a Dependent on account of the marriage, birth, adoption, or placement for adoption.
C. The applicant’s coverage under Medicaid or a state Children’s Health Insurance Program (CHIP) is terminated as a result of the applicant’s loss of eligibility for Medicaid or the CHIP, or the applicant becomes eligible for a premium assistance subsidy under Medicaid or a CHIP to obtain coverage under this Plan.
An applicant with special enrollment rights must make application for Participant Coverage during the Special Enrollment Period, which is generally during the first 30 days after the loss of other coverage or marriage, birth, adoption, or placement for adoption (whichever is applicable). However, if the loss of other coverage was caused by the application of the plan’s lifetime limit on all benefits, the Special Enrollment Period will occur during the 30-day period immediately following the first date on which a claim was denied for that reason. Further, in the case of the loss of Medicaid or CHIP eligibility or the gain of eligibility for a Medicaid or CHIP premium assistance subsidy, the Special Enrollment Period is during the first 60 days after the loss or gain of eligibility. Participant Coverage shall be effective as of the date of the loss of other coverage, the marriage, birth, adoption or placement for adoption, the loss of Medicaid or CHIP eligibility, or the gain of eligibility for a Medicaid or CHIP premium assistance subsidy.
An applicant with special enrollment rights who fails to make application for Participant Coverage during the Special Enrollment Period must wait until the next Annual Open Enrollment Period or until special enrollment rights again apply, whichever occurs first.
If written application for Participant Coverage was not made in the applicable timeframe outlined above, the applicant can still submit written application for Participant Coverage (as well as Dependent Coverage for his or her eligible spouse or children) to the Employer during the 2020 Calendar Year. As required by IRS Notice 2020-29, once the application has been made, Participant Coverage may then begin on a prospective date determined by the Employer.
All Participant Coverage under the Plan shall begin at 12:01 a.m. local time on the date on which coverage is to begin.
All other provisions of the Plan shall remain in effect and unchanged.
IN WITNESS WHEREOF, the undersigned has caused this amendment to be duly adopted and effective as of October 1, 2020.
Signatures on file in Human Resources.