SPECIAL ENROLLMENT PROVISION Under the Health Insurance Portability and Accountability Act This Plan gives each eligible person special enrollment rights if the person experiences a loss of other health coverage or a change in family status as explained below. The coverage choices that will be offered to You will be the same choices offered to other similarly situated Employees. LOSS OF HEALTH COVERAGE You and Your Dependents may have a special opportunity to enroll for coverage under this Plan if You experience a loss of other health coverage. In order for You to be eligible for special enrollment rights, You must meet the following conditions: • You and/or Your Dependents were covered under a group health plan or health insurance policy at the time coverage under this Plan was offered; and • The coverage under the other group health plan or health insurance policy was: ➢ COBRA continuation coverage and that coverage was exhausted; or ➢ Terminated because the person was no longer eligible for coverage under the terms of that plan or policy; or ➢ Terminated and no substitute coverage was offered; or ➢ No longer receiving any monetary contribution toward the premium from the employer. You or Your Dependent must request and apply for coverage under this Plan no later than 31 calendar days after the date the other coverage ended. You and/or Your Dependents were covered under a Medicaid plan or state child health plan and coverage for You or Your Dependents was terminated due to loss of eligibility. You must request coverage under this Plan within 60 days after the date of termination of such coverage. You or Your Dependents may not enroll for health coverage under this Plan due to loss of health coverage under the following conditions: • Coverage was terminated due to failure to pay timely premiums or for cause, such as making a fraudulent claim or an intentional misrepresentation of material fact, or • You or Your Dependent voluntarily canceled the other coverage, unless the current or former employer no longer contributed any money toward the premium for that coverage. NEWLY ELIGIBLE FOR PREMIUM ASSISTANCE UNDER MEDICAID OR CHILDREN’S HEALTH INSURANCE PROGRAM A current Employee and his or her Dependents may be eligible for a special enrollment period if the Employee and/or Dependents are determined eligible, under a state’s Medicaid plan or state child health plan, for premium assistance with respect to coverage under this Plan. The Employee must request coverage under this Plan within 60 days after the date the Employee and/or Dependents are determined to be eligible for such assistance. CHANGE IN FAMILY STATUS Current Employees and their Dependents, COBRA Qualified Beneficiaries, and other eligible persons have special opportunities to enroll for coverage under this Plan if they experience changes in family status. Retired Employees who are Covered Persons have special opportunities to enroll newly acquired Dependents for coverage under this Plan if they experience changes in family status. -39- 7670-00-413597