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AETNA PPO PLAN - My Benefits Portfolio - Trinity Health

AETNA PPO PLAN - My Benefits Portfolio - Trinity Health

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COBRA continuation coverage under another plan, you and/or your eligible Dependents must exhaust the<br />

COBRA coverage before you and/or your eligible Dependents may enroll in this Plan under a special<br />

enrollment period.<br />

If you timely enroll, coverage under the Plan for you and/or your eligible Dependents will be effective on<br />

the date the other coverage is terminated. If you do not timely enroll, enrollment for yourself and/or your<br />

new eligible Dependent(s) must wait until the next Annual Open Enrollment period, to be effective at the<br />

beginning of the next Plan Year (unless another event occurs which would allow you to enroll yourself<br />

and/or your new eligible Dependent(s) prior to such time).<br />

If you acquire a new eligible Dependent as a result of marriage, birth, adoption, or placement for<br />

adoption, you will be entitled to special enrollment in the Plan if you meet one of the following conditions:<br />

● Non-Enrolled Associate: If you are an eligible Associate but have not enrolled in the Plan, you may<br />

enroll upon your marriage, or upon the birth, adoption, or placement for adoption of your child.<br />

● Non-Enrolled Spouse: If you are an eligible Associate who is already enrolled in the Plan, you may<br />

enroll your spouse at the time of his or her marriage to you. You may also enroll your spouse if you<br />

acquire a child through birth, adoption, or placement for adoption.<br />

● New Dependents of an Enrolled Associate: If you are an eligible Associate who is already enrolled<br />

in the Plan, you may enroll a child who becomes your eligible Dependent as a result of marriage,<br />

birth, adoption, or placement for adoption.<br />

● New Dependents/Spouse of a Non-Enrolled Associate: If you are an eligible Associate but you are<br />

not enrolled in the Plan, you may enroll a spouse or child, as applicable, who becomes your eligible<br />

Dependent as a result of marriage, birth, adoption, or placement for adoption. However, you (the nonenrolled<br />

Associate) must also be eligible to enroll in the Plan, and actually enroll in the Plan at the<br />

same time.<br />

You must enroll yourself and/or your new eligible Dependent(s) no later than 30 days after the date of the<br />

event that entitles you and/or your eligible Dependent(s) to the special enrollment period. Coverage will<br />

become effective as of the date of the event. If you do not timely enroll, enrollment for yourself and/or<br />

your new eligible Dependent(s) must wait until the next Annual Open Enrollment period, to be effective at<br />

the beginning of the next Plan Year (unless another event occurs which would allow you to enroll yourself<br />

and/or your new eligible Dependent(s) prior to such time).<br />

In addition to the above, under the Children’s <strong>Health</strong> Insurance Program Reauthorization Act of 2009, you<br />

may enroll yourself and/or your eligible Dependent in the Plan if (1) you and/or your eligible Dependent<br />

lose Medicaid or Children’s <strong>Health</strong> Insurance Program (“CHIP”) coverage due to no longer being eligible<br />

for those benefits, or (2) you and/or your eligible Dependent become eligible for premium assistance in<br />

the Plan under a Medicaid program or CHIP. You must enroll in the Plan due to one of these reasons no<br />

later than 60 days after the date of the event that entitles you and/or your eligible Dependent to the<br />

special enrollment period. If you enroll within 60 days after the date of the event, coverage will become<br />

effective as of the date of the event. If you do not timely enroll, enrollment for you and/or your eligible<br />

Dependent must wait until the next Annual Open Enrollment period, to be effective at the beginning of the<br />

next Plan Year (unless another event occurs which would allow you to enroll yourself and/or your new<br />

eligible Dependent prior to such time).<br />

CHANGE IN STATUS<br />

The benefit choices you make are in effect for one entire Plan Year and generally may be changed only<br />

during the Annual Open Enrollment period. Elections you make during Annual Open Enrollment are<br />

effective beginning January 1 of the following Plan Year. The exception to this rule prohibiting election<br />

changes during a Plan Year is the occurrence of a special enrollment event described above or a<br />

qualified change in status event described in this section. Qualified change in status events include the<br />

following:<br />

16

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