in this booklet, the provision which provides the better benefit will apply.
Termination of Insurance
HC-FED1
10-10
Employees Your insurance will cease on the earliest date below: the last day of the calendar month in which you cease to be in a Class of Eligible Employees or cease to qualify for the insurance. the last day of the calendar month in which you have made any required contribution for the insurance. the date the policy is cancelled. the last day of the calendar month in which your Active Service ends except as described below. Any continuation of insurance must be based on a plan which precludes individual selection. Temporary Layoff or Leave of Absence If your Active Service ends due to temporary layoff or leave of absence, your insurance will be continued until the date as determined by your Employer. Injury or Sickness If your Active Service ends due to an Injury or Sickness, your insurance will be continued while you remain totally and continuously disabled as a result of the Injury or Sickness. However, your insurance will not continue past the date your Employer cancels your insurance. Dependents Your insurance for all of your Dependents will cease on the earliest date below: the date your insurance ceases. the date you cease to be eligible for Dependent Insurance. the last day for which you have made any required contribution for the insurance. the date Dependent Insurance is cancelled. The insurance for any one of your Dependents will cease on the last day of the calendar month of which the date that Dependent no longer qualifies as a Dependent.
Qualified Medical Child Support Order (QMCSO) Eligibility for Coverage Under a QMCSO If a Qualified Medical Child Support Order (QMCSO) is issued for your child, that child will be eligible for coverage as required by the order and you will not be considered a Late Entrant for Dependent Insurance. You must notify your Employer and elect coverage for that child, and yourself if you are not already enrolled, within 31 days of the QMCSO being issued. Qualified Medical Child Support Order Defined A Qualified Medical Child Support Order is a judgment, decree or order (including approval of a settlement agreement) or administrative notice, which is issued pursuant to a state domestic relations law (including a community property law), or to an administrative process, which provides for child support or provides for health benefit coverage to such child and relates to benefits under the group health plan, and satisfies all of the following: the order recognizes or creates a child’s right to receive group health benefits for which a participant or beneficiary is eligible; the order specifies your name and last known address, and the child’s name and last known address, except that the name and address of an official of a state or political subdivision may be substituted for the child’s mailing address; the order provides a description of the coverage to be provided, or the manner in which the type of coverage is to be determined; the order states the period to which it applies; and if the order is a National Medical Support Notice completed in accordance with the Child Support Performance and Incentive Act of 1998, such Notice meets the requirements above. The QMCSO may not require the health insurance policy to provide coverage for any type or form of benefit or option not otherwise provided under the policy, except that an order may require a plan to comply with State laws regarding health care coverage.
HC-TRM128 M
12-17
Federal Requirements The following pages explain your rights and responsibilities under federal laws and regulations. Some states may have similar requirements. If a similar provision appears elsewhere
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