SSMC Employee Health Benefit Plan
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d. Changing from individual coverage to family coverage any time you acquire a Spouse or Dependent
child or elect to enroll a previously eligible, but non-enrolled Spouse or Dependent child;
e. Changing from family coverage to individual coverage any time you no longer have Eligible
Dependents or when you no longer wish to provide coverage for Dependents;
f. Changing from two individual enrollments to one family coverage, or from one family coverage to two
individual enrollments, when you or your Spouse are both eligible as Employees;
g. Changing or adding new Dependents, or removing existing Dependents, from family coverage; or
h. Reporting other group plan(s) and Medicare coverage information and changes.
C. Effective Dates of Benefits
The SSMC Human Resources Department can provide full details concerning the Effective Date of benefits for
you or your Dependents. The following are general rules for Effective Dates of benefits:
1. Eligible Employment. To be eligible for Plan benefits, you must be in eligible employment (on SSMC
payroll as an eligible Employee) on the Effective Date of your Plan coverage or the date your Dependent's
coverage becomes effective. You must be in eligible employment to be eligible for Plan changes unless on
unpaid FMLA or Continuing Coverage under USERRA or COBRA. If you return to eligible employment
at a later date, you may need to establish another Waiting Period and make a new enrollment. Plan benefits
will not be paid for any expenses Incurred by any person before their Effective Date of Plan coverage.
2. Employment Waiting Periods. If you enroll in the Plan before the applicable Waiting Periods have
elapsed, coverage will automatically become effective when the Waiting Periods have been met, if you are
an eligible Employee at that tim e. Benefits will not be payable for any expenses Incurred during a Waiting
Period. Coverage begins no sooner than the first day of month following the applicable Waiting Periods of
three full months (including sick days) for eligible Employees working more than 30 hours per week or six
full months (including sick days) for eligible part-time Employees working more than 22.50 hours but less
than 30 hours per week.
Please Note
You will receive credit for previous accumulated Waiting Periods if you, the Employee, lost eligible employment
status with SSMC (laid-off, shorter hours etc.), and return to eligible employment within six months. If you return to
eligible employment status six months or more after you lost eligible employment status, you must again accumulate
the full employment Waiting Periods. Exception: You will receive credit for previously accumulated Waiting Periods
if you return to eligible employment during a period of COBRA continuation. If you return to work at the end of U. S.
military service, you could be eligible for immediate Plan enrollment when you meet the requirements of the
Uniformed Services Employment and Reemployment Rights Act (USERRA), a Federal law. The SSMC Human
Resources can provide full details concerning USERRA reinstatement.
3. Employee Effective Date
a. On Effective Date of the Plan. Each Employee in an eligible class whose employment commenced
on or before the Effective Date of the Plan will be Covered on the Effective Date of the Plan if:
1) He or she was continuously employed by SSMC as an eligible Employee for at least three full
months (six full months for eligible Employees working less than 30 hours per week) at the time
this Plan became effective; or
2) He or she was enrolled as an eligible Employee in the previous Plan when this Plan went into
effect; and
3) He or she is in eligible employment and enrolls in this Plan at the time this Plan became effective.
b. Employment after Effective Date of Plan. If your employment in an eligible class starts after the
Plan Effective Date, your eligibility date for Plan enrollment is 12:01 on the first day of the month after
three full months (including sick days) of continuous eligible employment (six full months, including
sick days, for eligible part-time Employees working 20.50 to 30 hours per week). If you enroll before
the end of the Waiting Period or within 31 days after the Waiting Period, coverage will begin on your
