92 All enrolled eligible children will continue to be covered until the age limit listed in the Schedule of Benefits. Coverage may be continued past the age limit in the following circumstance: • For those already enrolled Dependents who cannot work to support themselves due to mental, intellectual, or physical impairment. The Dependent’s impairment must start before the end of the period they would become ineligible for coverage. The Plan must be informed of the Dependent’s eligibility for continuation of coverage within 120 days after the Dependent would normally become ineligible. You must then give proof as often as the Plan requires. This will not be more often than once a year after the two-year period following the child reaching the limiting age. You must give the proof at no cost to the Plan. You must notify the Claims Administrator or the Employer if the Dependent’s marital status changes and they are no longer eligible for continued coverage. You may be required to give proof of continued eligibility for any enrolled child. Your failure to give this information could result in termination of a child’s coverage. To obtain coverage for children, you may be required to give the Claims Administrator and/or Employer a copy of any legal documents awarding guardianship of such child(ren) to you. Types of Coverage Your Employer offers the enrollment options listed below. After reviewing the available options, you may choose the option that best meets your needs. The options are as follows: • Subscriber only (also referred to as single coverage); • Subscriber and spouse; or Domestic Partner; • Subscriber and one child; • Subscriber and children; • Subscriber and family. When You Can Enroll Initial Enrollment The Employer will offer an initial enrollment period to new Subscribers and their Dependents when the Subscriber is first eligible for coverage. Coverage will be effective based on the waiting period chosen by the Employer, and will not exceed 90 days. If you did not enroll yourself and/or your Dependents during the initial enrollment period you will only be able to enroll during an Open Enrollment period or during a Special Enrollment period, as described below. Open Enrollment Open Enrollment refers to a period of time, usually 60 days, during which eligible Subscribers and Dependents can apply for or change coverage. Open Enrollment occurs only once per year. The Employer will notify you when Open Enrollment is available. Special Enrollment Periods If a Subscriber or Dependent does not apply for coverage when they were first eligible, they may be able to join the Plan prior to Open Enrollment if they qualify for Special Enrollment. Except as noted otherwise below, the Subscriber or Dependent must request Special Enrollment within 31 days of a qualifying event.

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