PPO/DRP Medical Plan - Advocate Benefits - Advocate Health Care

Additional information about coverage during a
military leave of absence is available online at
www.advocatebenefits.com (click on Benefits
Information > Leave of Absence > Leave of
Absence Policy).
Coverage If You Become Disabled
If you are receiving disability benefits, you may
continue your medical coverage for up to 12
months after becoming disabled, as long as you
continue to pay your required contributions.
You must pay your portion of the cost through
payroll deduction, by personal check or money
order on an ongoing basis or your coverage will
be discontinued. Benefit elections and payments
must be kept current, or your coverage will
be discontinued.
What happens if I am no longer eligible
for benefits?
The PPO/DRP allows covered associates and
their covered family members to continue
certain medical benefit coverage at their own
expense when they would otherwise lose
coverage (see Continuation of Coverage).
Continuation of Coverage
The Plan allows covered associates and their
covered family members to continue certain types
of health care coverage at their own expense when
they would otherwise lose coverage.
Qualifying Events for Associates and
Covered Dependents
Coverage can continue for you and/or your
covered family members for 18 months if you
experience a qualifying event. Qualifying events
can occur when you lose your coverage because:
Your work hours are reduced or you otherwise
lose eligibility for health benefits,
You resign,
Your employment with the Advocate
Companies ends (except for gross misconduct),
You are laid off from work,
You take a leave of absence, or
You retire.
Continuing coverage also is available to your
covered family members if their coverage
ends because:
You die,
You get a divorce, an annulment or become
legally separated,
You terminate employment with the
Advocate Companies (for reasons other
than gross misconduct),
You experience a reduction in work hours,
Your dependent is no longer eligible under
the Plan, or
You become eligible for Medicare.
Your covered family members can also choose
to continue coverage for up to 36 months if they
lose their eligibility for coverage (for example,
your dependent reaches the dependent age limit).
If one of these qualifying events occurs while a
dependent is already continuing coverage, his
or her coverage may be extended for up to 36
months from the date of the first event.
To be eligible for this extension, you or your
dependents must notify the continuation of
coverage administrator within 60 days of the
second event.
Note: If you have a newborn child or a child
is placed for adoption with you while you are
covered under continuing coverage, that child
can also receive continuing coverage for the
duration of your coverage. You must notify the
Plan Administrator within 90 days of the birth or
placement for adoption for the child to be covered
as of the date of birth or placement for adoption.
In this case, the child will have the same rights as
any dependent covered immediately prior to your
eligibility for continuing coverage.
Continuation of Coverage and Disability
If you are disabled, as determined by the Social
Security Administration, on the date you lose
coverage or you become disabled during the first
60 days of continuing coverage, you can continue
coverage for a total of 29 months (that is, for 11
additional months). You must notify the continuation
of coverage administrator within 60 days of the
determination of disability, and this notice must be
received within the first 18 months of coverage.
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