4.13 SR 05-06-2024 - Laserfiche WebLink

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© 2012 Hitesman & Wold, P.A. City of Elk River Flexible Benefits Plan 11 dependent gains eligibility for coverage under another employer’s cafeteria plan (or another employer’s qualified benefit plan) as a result of a change in marital status or a change in employment status, a Participant may elect to cease or decrease coverage only if that coverage becomes actually effective or is increased under the other employer’s plan. (3) Dependent Care Expense Reimbursement Plan. With respect to the Dependent Care Expense Reimbursement Plan, a Participant may change or terminate his or her Election only if (i) such a change or termination is made on account of and corresponds with a Change in Status that affects eligibility for coverage under the Plan; or (ii) the Election change is on account of and corresponds with a Change in Status that affects eligibility of dependent care expenses for the tax exclusion available under the Code. (4) Group Term Life Insurance and Disability Income Coverage. For a Change of Status involving a Participant’s legal marital status or the employment status of a Participant’s Spouse or dependent (disregarding the requirement that the event cause a loss or gain of eligibility), a Participant may elect either to increase or to decrease group term life insurance or disability income coverage offered under the Plan. (5) COBRA Coverage. If the Participant becomes eligible for COBRA (or similar health plan continuation coverage under state law) under a group health plan sponsored by the Employer, the Participant may increase the Election for that Optional Benefit to pay for such coverage provided the Participant is still eligible under the Plan and still receiving Compensation. (b) HIPAA Special Enrollment Rights. If a Participant, a Participant’s Spouse, and/or a Participant’s dependent enrolls in a group health plan that is an Optional Benefit of this Plan pursuant to the HIPAA special enrollment rights provided by Code § 9801(f), the Participant may make a new election that corresponds with the special enrollment. For purposes of this provision (1) an Election to add previously eligible dependents as a result of the acquisition of a new Spouse or dependent child (a/k/a the Tag-along Rule), shall be considered consistent with the special enrollment right; and (2) a HIPAA special enrollment Election attributable to the birth or adoption of a new dependent child may be effective retroactive (up to thirty (30) days), provided it applies to Compensation not yet currently available. (c) Certain Judgments, Decrees and Orders. If a judgment, decree, or order (an “Order”) resulting from a divorce, legal separation, annulment or change in legal custody (including a qualified medical child support order) requires accident or health coverage for a Participant’s dependent child (including a foster child who is a dependent of the Participant), a Participant may: (1) change his or her Election to provide coverage for the dependent child (provided that the Order requires the Participant to provide coverage and subject to the provisions of the underlying group health plan); or (2) change his or her Election to revoke coverage for the dependent child if the Order requires that another individual (including the Participant’s Spouse or former Spouse) provide coverage under that individual’s plan. (d) Medicare and Medicaid. If a Participant, a Participant’s Spouse, or a Participant’s dependent who is enrolled in a health or accident benefit under this Plan (including the Health Care Expense Reimbursement Plan and Limited Scope Health Care Expense Reimbursement Plan) becomes entitled to Medicare or Medicaid (other than coverage consisting solely of benefits under Section 1928 of the Social Security Act providing for pediatric vaccines), the Participant may prospectively reduce or cancel the health or accident coverage of the person becoming entitled to Medicare or Medicaid. Further, if a Page 104 of 254