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than 31 days from the date of the qualifying event will be returned, and coverage will not be available.

As part of the application process, proof of the qualifying event may be required. If these requirements are met, coverage under the Plan will take effect on the date of the qualifying event. In the case of a Qualified Medical Child Support Order, the coverage will be effective the 1st day of the month following the date of the Order.

The enrollee may also apply for High Option for Children when adding dependent children up to age 18.

Special Enrollment Period for a dependent returning to full-time student status An eligible dependent between the ages of 19 and 25 who is returning to school as a full-time student at an accredited high school, college, or university, may be enrolled for coverage under the Plan. The date of the qualifying event is the date the dependent returns to school.

An Application for Coverage form must be submitted within 31 days of the qualifying event, and the appropriate premium payments must be made. The effective date of the coverage will be the date of the qualifying event.

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.

Transferring Dependent Coverage A retiree may transfer dependent coverage from another contract under the Plan. For example: A retiree’s spouse has coverage under the Plan as an active employee, the spouse terminates employment and is not eligible to retire. The retiree can add the spouse and any other dependents covered under the spouse’s contract. The retiree must complete an Application for Coverage form within 31 days of the spouse leaving employment and pay the appropriate premiums. Any Application for Coverage form received by Blue Cross & Blue Shield more than 31 days from the date the spouse loses coverage due to termination of employment will be returned, and coverage will not be available.

Reemployment A covered retiree who returns to work (other than full-time) with a covered employer unit while continuing to receive retirement benefits will remain covered as a retired employee. The retired employee will not be eligible for employer-paid coverage as an active employee under the Plan.

A retiree who returns to full-time employment with a covered employer unit and terminates retirement benefits is eligible for employer-paid coverage as an active employee.

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