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If timely application is made and appropriate premiums are paid, the effective date of coverage for the employee and any eligible dependent(s) will be the first day of employment. If an employee does not enroll or if he waives coverage within 31 days of employment, application may be made only during an open enrollment or special enrollment period. Enrollment periods are discussed later in this section.

All new employees and their dependents applying for coverage are subject to a twelve (12) month pre-existing condition exclusion period. If the enrollee and/or dependents had other health care coverage defined as “creditable coverage” under the Health Insurance Portability and Accountability Act (HIPAA), and that other coverage terminated within 63 days of the effective date with this Plan, the prior health coverage will be credited against the 12-month pre-existing condition exclusion under the Plan. In order to reduce the pre-existing condition exclusion period, the employee must provide proof of prior creditable coverage.

High Option for Children An enrollee may apply for High Option for Children, if the enrollee has a covered dependent or is adding a dependent under the age of 18.

Disabled Dependent New employees who wish to enroll a disabled dependent must submit a Handicapped Dependent form along with the Application for Coverage form. This form can be obtained from Blue Cross & Blue Shield. Blue Cross & Blue Shield will make final determination of disability. The disabling condition must have occurred prior to the dependent’s 19th birthday.

Student Verification Student verification letters to confirm student status are sent by Blue Cross & Blue Shield to enrollees with covered dependent children at the time the dependent child becomes nineteen (19). If the enrollee does not verify full-time student status prior to a dependent child’s 19th birthday, coverage for the dependent will end at the end of the month in which he turns 19. Written proof of full-time student status may be requested at any time. Such proof may be required in order for a dependent child between the ages of 19 and 25 to remain covered under the Plan.

Right to Request Documentation If required, documentation of dependent relationship, such as marriage license or birth certificate, must be provided. To enroll a child due to adoption, placement in anticipation of adoption, legal guardianship, or legal custody, a copy of the applicable court order must be submitted with the Application for Coverage form.

Paying for Coverage The State pays the cost of coverage for all active Legacy Employees. The State pays the cost of Base Coverage for all active Horizon Employees. Horizon Employees may enroll in Select Coverage and pay a portion of the premium. The cost for dependent coverage is the enrollee’s


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