Cigna Dental PPO Low Option Summary Plan Description

 you are an eligible, full-time Employee; and  you normally work at least 30 hours a week; and  you pay any required contribution.

Effective Date of Dependent Insurance Insurance for your Dependents will become effective on the date you elect it by completing the Employer’s specified enrollment process, but no earlier than the day you become eligible for Dependent Insurance. All of your Dependents as defined will be included. Your Dependents will be insured only if you are insured. Late Entrant – Dependent You are a Late Entrant for Dependent Insurance if:  you elect that insurance more than 31 days after you become eligible for it; or  you again elect it after you cancel your payroll deduction (if required).

If you were previously insured and your insurance ceased, you must satisfy the New Employee Group Waiting Period to become insured again. Initial Employee Group: You are in the Initial Employee Group if you are employed in a class of employees on the date that class of employees becomes a Class of Eligible Employees as determined by your Employer. New Employee Group: You are in the New Employee Group if you are not in the Initial Employee Group. Eligibility for Dependent Insurance Insurance for your Dependents will become effective on the date you elect it by completing the Employer’s specified enrollment process, but no earlier than the day you become eligible for Dependent Insurance.

HC-ELG195 M

12-17

 the day you become eligible for yourself; or  the day you acquire your first Dependent.

Waiting Period First of the Month on or after 30 days of active service. Classes of Eligible Employees Each Employee as reported to the insurance company by your Employer. Effective Date of Employee Insurance You will become insured on the date you elect the insurance by completing the Employer’s specified enrollment process, but no earlier than the date you become eligible. You will become insured on your first day of eligibility, following your election, if you are in Active Service on that date, or if you are not in Active Service on that date due to your health status. Late Entrant - Employee You are a Late Entrant if:  you elect the insurance more than 31 days after you become eligible; or  you again elect it after you cancel your payroll deduction (if required). Dependent Insurance For your Dependents to be insured, you will have to pay the required contribution, if any, toward the cost of Dependent Insurance.

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