SSMC Employee Health Benefit Plan
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5. Leave of Absence. You could have Plan eligibility for individual or family coverage extended during your
authorized leave of absence. The following are general rules for these eligibility extensions. The SSMC
Human Resources Department can give you full details concerning extension of Plan eligibility and the
costs for continued Plan participation.
a. Authorized Leave of Absence. You may retain your individual coverage or family coverage under
the Plan for an approved leave of absence due to Total Disability or other leave when authorized by
SSMC, according to its established rules or according to Federal and State laws including the Family
and Medical Leave Act shown below. If any part of the leave is without pay, you must submit your
designated Participation Payment, if any, on a timely bas is to maintain coverage.
If you continue to be absent from work beyond the approval period, your Plan coverage will end at
midnight on the last day of your approved absences. However, you and your Dependents may be
eligible for Continuing Coverage under COBRA shown later in this section. If you fail to pay a
scheduled Participation Payment, if any, within 31 days of the due date, coverage will end for you and
your Dependents at the end of the month for which your last Participation Payment was made. If Plan
coverage ends while you are absent from work, you cannot be reinstated until you return to work and
enroll in the Plan. You will be considered a new Employee if more than 6 months have passed since
your last day of approved absence.
b. Family and Medical Leave Act. Under the Family and Medical Leave Act (FMLA) of 1993, a
federal law, eligible Employees are entitled to receive up to 12 weeks of unpaid leave in any 12
consecutive months for certain family and medical reasons. If you are on an FMLA leave of absence,
you may continue Plan coverage by paying the designated Participation Payment, if any, for Individual
or Family coverage. Plan continuation will be according to the FMLA law, as amended. The SSMC
Human Resources Department can provide the details of your rights under the FMLA and your costs to
continue coverage while on the FMLA. An FMLA absence could run concurrent with other SSMC
authorized leave of absence.
B. Enrollment
Persons cannot enroll in more than one SSMC sponsored health Plan as an Employee or retiree nor be enrolled both as
an Employee/Retiree and a Dependent nor as a Dependent of more than one Employee/Retiree. Enrollment in the Plan is
not automatic. You are required to enroll yourself and your Dependents. The SSMC Human Resources Department can
provide forms and explanations needed for any enrollment updates or changes . Failure to report enrollment changes
could result in Plan overpayment. Should this happen, you may be required to reimburse the full amount of any
overpayment.
You must be in eligible employment to enroll in the Plan. Your enrollment options are as follows:
1. Individual or Personal Coverage. Employee or a COBRA participant is enrolled. Plan covers only that
eligible and enrolled person even if other members of the family meet eligibility requirements.
2. Family Coverage - Schedule A Benefits Only. Employee and one or more Eligible Dependents are
enrolled. It also includes a surviving Spouse, ex-Spouse and one or more of his/her Dependents under
COBRA continuation of coverage. Coverage provides benefits only for the eligible and enrolled persons,
even if other family members meet eligibility requirements.
3. Enrollment Changes. It is your responsibility to apply for any enrollment changes including, but not
limited to:
a. Adding a newly acquired Spouse or Dependent child;
b. Adding an existing Spouse previously enrolled as an Employee;
c. Adding a previously eligible, but non-enrolled Spouse or Dependent child;
