SSMC Employee Health Benefit Plan
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eligibility date. If you do not enroll within 31 days after the Waiting Period, coverage begins no
sooner than the Effective Dates shown later in this section under Special Enrollment Effective Dates.
4. Dependent General Rules-Schedule A Only . Coverage for your Dependents becomes effective on same
date as your Effective Date if they are enrolled at the time of your initial enrollment. If you did not enroll
existing Dependents at the time of your initial enrollment, coverage for Dependents begins no sooner than
the Effective Dates shown later in this section under Special Enrollment Effective Dates.
5. Special Enrollment Effective Dates.
a. Adding New Dependents.
1) After your initial enrollment, when you acquire new Dependents and enroll the new Dependents in
family coverage within 31 days after the date acquired, Plan coverage for the new Dependents will
begin on the date you acquired the Dependents, but no sooner than your Effective Date of your
own coverage. You will be required to pay the family coverage Participation Payments, if any.
2) If you are an active Employee and not enrolled in the Plan when you acquire a Spouse, you may
enroll yourself and your Spouse under family coverage. If you acquire a Newborn child, or a
newly placed or adopted child (under Age 18), you may enroll yourself and/or your Spouse and the
newly acquired Newborn child, newly placed for adoption or adopted child under family coverage.
For coverage to be effective on the date you acquired the new Dependent (but no sooner than the
first day of the month following your applicable Waiting Period), you must enroll yourself and
new Dependents within 31 days after the date of marriage, birth, placement for or adoption,
whichever applies. This immediate coverage rule does not apply to children existing at the time of
your initial eligibility.
3) If you fail to enroll yourself or Dependents within 31 days from the date the Dependents were
acquired, Cancellation of Another Health Plan or Late Entrant Enrollment rules shown below
apply.
b. Cancellation of Another Health Plan. Eligible persons who were not enrolled in this Plan under
active Employee coverage, due to other health plan coverage, may elect coverage under this P lan. To
be effective from the date the other coverage ended, but no sooner than your applicable Waiting Period,
the following conditions must be met:
1) Person had health coverage at the time this coverage was previously offered;
2) Person stated in writing at the time he or she declined enrollment in this Plan that the reason for
declining was due to the other coverage;
3) The other coverage was involuntarily terminated due to loss of eligibility; or exhaustion of the
prior plan continuation of coverage; or cessation of employer Contributions to the other plan; or
cancellation of coverage by the employer, insurer, or other issuing entity; and
4) Person requests enrollment within 31 days after the date the other plan was canceled.
If you fail to enroll yourself or Dependents within 31 days after involuntary cancellation of the other
plan, coverage begins no sooner than the Late Entrant Enrollment Effective Date shown below. This
Late Entrant rule also applies to persons who voluntarily cancel the other plan then seek late enrollment
in this Plan. Voluntary cancellation includes, but is not limited to, cancellation or withdrawal from the
other coverage by the Enrollee; removal of Dependents from family coverage by the Enrollee; or
cancellation of coverage due to Enrollee fraud or Enrollee nonpayment of required participation
premiums or Contributions.
c. Late Entrant Enrollment. If you fail to enroll yourself or your Dependents when first eligible, or
under the Adding New Dependents and Cancellation of Another Health Plan rules shown above,
coverage begins 12:01 A. M. on the first day of the month after the date SSMC Human Resources
accepts your Employee or Dependent enrollment application, but no sooner than the first day of the
