IMPORTANT INFORMATION REGARDING YOUR MEDICAL BENEFITS ( CONTINUED )
Loss of Other Coverage ( Excluding Medicaid or a State Children ’ s Health Insurance Program ). If you decline enrollment for yourself or for an eligible dependent ( including your spouse ) while other health insurance or group health plan coverage is in effect , 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 31 days after your or your dependents ’ other coverage ends ( or after the employer stops contributing toward the other coverage ).
Loss of Coverage for Medicaid or a State Children ’ s Health Insurance Program . If you decline enrollment for yourself or for an eligible dependent ( including your spouse ) while Medicaid coverage or coverage under a state children ’ s health insurance program is in effect , you may be able to enroll yourself and your dependents in this plan if you or your dependents lose eligibility for that other coverage . However , you must request enrollment within 60 days after your or your dependents ’ coverage ends under Medicaid or a state children ’ s health insurance program .
New Dependent by Marriage , Birth , Adoption , or Placement for Adoption . If you have a new dependent as a result of marriage , birth , adoption , or placement for adoption , you may be able to enroll yourself and your new dependents . However , you must request enrollment within 31 days after the marriage and 60 days after the birth , adoption , or placement for adoption .
Eligibility for Premium Assistance Under Medicaid or a State Children ’ s Health Insurance Program – If you or your dependents ( including your spouse ) become eligible for a state premium assistance subsidy from Medicaid or through a state children ’ s health insurance program with respect to coverage under this plan , you may be able to enroll yourself and your dependents in this plan . However , you must request enrollment within 60 days after your or your dependents ’ determination of eligibility for such assistance .
To request special enrollment or to obtain more information about the plan ’ s special enrollment provisions , contact Lori Crowell - Human Resources at 360.394.8635 or lcrowell @ suquamish . nsn . us .
Important Warning
If you decline enrollment for yourself or for an eligible dependent , you must complete our form to decline coverage . On the form , you are required to state that coverage under another group health plan or other health insurance coverage ( including Medicaid or a state children ’ s health insurance program ) is the reason for declining enrollment , and you are asked to identify that coverage . If you do not complete the form , you and your dependents will not be entitled to special enrollment rights upon a loss of other coverage as described above , but you will still have special enrollment rights when you have a new dependent by marriage , birth , adoption , or placement for adoption , or by virtue of gaining eligibility for a state premium assistance subsidy from Medicaid or through a state children ’ s health insurance program with respect to coverage under this plan , as described above . If you do not gain special enrollment rights upon a loss of other coverage , you cannot enroll yourself or your dependents in the plan at any time other than the plan ’ s annual open enrollment period , unless special enrollment rights apply because of a new dependent by marriage , birth , adoption , or placement for adoption , or by virtue of gaining eligibility for a state premium assistance subsidy from Medicaid or through a state children ’ s health insurance program with respect to coverage under this plan .
HEALTHCARE REFORM & YOUR BENEFITS
The Suquamish Tribe offers a medical plan option that provides valuable comprehensive coverage that meets the requirements of the healthcare reform law and is intended to be affordable as defined by the law . Also note , it ’ s unlikely that you are eligible for financial help from the government to help you pay for insurance purchased through a Marketplace because you have access to an employer plan that complies with the affordability standard .
PREVENTIVE CARE
Certain preventive care services must be provided by non-grandfathered group health plans without member cost-sharing ( such as deductibles or copays ) when these services are provided by a network provider . Please refer to your insurance company for more information . Contact information is listed under “ Your Benefits Contacts ” in the back of this Guide .
Prepared by Gallagher for the Employees of The Suquamish Tribe 13