Am I Eligible and How Do I Enroll? Property of Bind Benefits, Inc., d/b/a Surest. All rights reserved © 2026. 5 • You or your eligible dependent who were enrolled in an HMO no longer live or work in that HMO's service area and no other benefit option is available to you or your eligible dependent. • Benefits are no longer offered by the plan to a class of individuals that include you or your eligible dependent. • Termination of your or your dependent's Medicaid or Children's Health Insurance Program (CHIP) coverage as a result of loss of eligibility (you must contact the Plan Administrator within 60 days of termination). • You or your dependent become eligible for a premium assistance subsidy under Medicaid or CHIP (you must contact the Plan Administrator within 60 days of the date of determination of subsidy eligibility). • You or your dependent lose eligibility for coverage in the individual market, including coverage purchased through a public exchange or other public market established under the Affordable Care Act (Marketplace) (other than loss of eligibility for coverage due to failure to pay premiums on a timely basis or termination of coverage for cause, such as making a fraudulent claim or an intentional misrepresentation of a material fact) regardless of whether you or your dependent may enroll in other individual market coverage, through or outside of a Marketplace. • A strike or lockout involving you or your spouse. • A court or administrative order. Unless otherwise noted above, if you wish to change your elections, you must contact the Plan Administrator within 31 days of the change in family status. Otherwise, you will need to wait until the next Open Enrollment. While some of these changes in status are similar to qualifying events under COBRA, you or your eligible dependent do not need to elect COBRA continuation coverage to take advantage of the special enrollment rights listed above. These will also be available to you or your eligible dependent if COBRA is elected. Note: Any child under the age of 26 who is placed with you for adoption will be eligible for coverage on the date the child is placed with you, even if the legal adoption is not yet final. If you do not legally adopt the child, all medical Surest Plan coverage for the child will end when the placement ends. No provision will be made for continuing coverage (such as COBRA coverage) for the child. Special Enrollment Period for Medicaid and Children’s Health Insurance Program (CHIP) Participants If an eligible employee and/or his/her eligible dependents are covered under a state Medicaid Plan or a state CHIP (if applicable) and that coverage is terminated as a result of loss of eligibility, then such employee may request enrollment in the Plan on behalf of him/herself and/or eligible dependents. Such request shall be submitted to the Plan Administrator no later than 60 calendar days after the eligible employee’s and/or his/her dependent’s coverage ends under such state plans.