Welfare Summary Plan Description

1.6 INITIAL ENROLLMENT, OPEN ENROLLMENT, AND SPECIAL LATE ENROLLMENT RULES

Initial Enrollment and Requalification as an Active Employee

When you first have Employer contributions made to a Dollars Bank account containing no Employer contributions or when you first become eligible (or requalify) for Plan coverage based on Employer contributions, the Plan will notify you that you have the option to elect coverage at one of the Plan Levels -- Employee-Only, Employee-Plus, or Family, using an approved enrollment form provided by the Plan. This initial coverage election period will end 45 days after you first become eligible (or requalify) for Plan coverage. If you do not properly elect coverage on an approved enrollment form and provide all required documentation during the initial coverage election period, you will automatically have your coverage election set as Employee-Only.

Your coverage election can be changed at any time during the 45-day coverage election period, by providing a new properly-completed enrollment form and all required documentation. After the initial coverage election period ends, your initial coverage election can only be changed at the next annual Open Enrollment set by the Plan, or if you qualify for Special Enrollment because of one of the changes described below.

Open Enrollment

The Plan will set an Open Enrollment period each year during which you may change the Plan Level that you have selected. If you do not provide a properly-completed new election form during this Open Enrollment period, your previously-selected Plan Level (Employee-Only, Employee-Plus, or Family) will remain in effect and cannot be changed until the next Open Enrollment or Special Enrollment period that applies to you. Active Employees and COBRA participants will be allowed to make election changes during Open Enrollment.

Special Enrollment

Active Employees and COBRA participants may change the election of Plan Level coverage in any of the following Special Enrollment periods provided that a completed Special Enrollment form has been received by the Trust office and you agree to and make the required Self-Payment contributions in the first 60 days from the date in which the Qualifying Event occurred:

  1. Within 60 days following marriage or divorce of the Employee.
  2. Within 60 days of birth, adoption, or placement for adoption of a child who would qualify as an eligible Dependent of the Employee under the terms of the Plan at the Employee-Plus or Family coverage levels.
  3. Within 60 days of the death of a spouse, child, or child placed with the Employee for adoption who is eligible for coverage under this Plan as a Dependent under the Employee-Plus or Family coverage levels.
  4. Within 60 days of a loss of coverage to an Employee or, an Employee's Spouse, or an Employee's Dependent where that individual is not enrolled in this Plan but would be eligible for coverage under this Plan at one of the Plan Levels, and the loss of coverage is from another health insurance policy or program (including any COBRA Continuation Coverage, individual insurance, or a public program such as Medicaid), if the other coverage terminated due to any of the following reasons: (1) termination of employment or reduction in the number of hours of employment, or death, divorce or legal separation; (2) termination of employer contributions toward the other coverage; or (3) if the other coverage was COBRA coverage, the exhaustion of that coverage. COBRA coverage is "exhausted" if it ceases for any reason other than failure of the individual to pay premiums on a timely basis.
  5. Within 60 days of an Employee's Spouse or Dependent newly becoming eligible or re-qualifying for coverage under another health insurance policy or program (including any COBRA Continuation Coverage, individual insurance, or a public program such as Medicaid). If an Active Employee is not in an open enrollment or Special Enrollment period and is enrolled in Employee- Plus coverage but does not have any eligible Dependents, his or her Plan Level will be automatically changed to Employee-Only.

    If an Active Employee is not in an open enrollment or Special Enrollment period and is enrolled in Family coverage but either does not have any eligible children, or does not have an eligible Spouse, his or her Plan Level will be automatically changed to Employee-Plus.