Benefits for 2024
Legal Notices
HIPAA Special EnrollmentNotice
If you are declining enrollment for yourself or your dependents (including your spouse) because of other health insurance or group health plan coverage, you may be able to enroll yourself and your dependents in this plan if you or your dependents lose eligibility for that other coverage (or if the employer stops contributing toward your or your dependents’ other coverage). However, you must request enrollment within 30 days after your or your dependents’ other coverage ends (or after the employer stops contributing toward the other coverage). In addition, if you have a new dependent as a resultof marriage, birth, adoption, or placement for adoption, you maybe able to enroll yourselfandyourdependents. However,youmustrequestenrollmentwithin30daysafterthemarriage,birth,adoption,orplacement for adoption. If you or your dependents lose eligibility for coverage under Medicaid or the Children’s Health Insurance Program (CHIP) or become eligible for a premium assistance subsidy under Medicaid or CHIP, you may be able to enroll yourself and your dependents. You must request enrollment within 60 days of the loss of Medicaid or CHIP coverage or the determination of eligibility for a premium assistance subsidy.To request specialenrollment or to obtain moreinformationabout the plan's special enrollment provisions,contact the plan administrator.
This booklet provides only a summary of your benefits. All services described within are subject to the definitions, limitations, and exclusions set forth in each insurance carrier or provider’s contract.
2024 Employee Benefit Guide
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