SSMC Employee Health Benefit Plan
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or handicapped child based on submitted proof of disability and examination results.
Coverage may be stopped immediately if you or your Dependent knowingly submits a claim or allows a
claim to be submitted with false information, or conceals any facts that could affect the outcome of a claim
determination. Cancellation of your coverage due to these actions on the part of yourself or your
Dependents is not considered a qualifying event under COBRA. In this case, you or your Dependents
cannot elect Continuing Coverage under COBRA.
F. Extended Coverage for Total Disability
This extended coverage is in addition to coverage available under the optional Continuing Coverage under COBRA
shown later in this Section and time limits are concurrent with continuation coverage.
If a Covered Person is totally disabled; under a doctor's care; and not covered by another group health plan at
the time his or her coverage under this Plan ends, limited coverage will continue to be available for the disabled
person only. This extension is not available if coverage ended because the Employee failed to make the
required Participation Payment. These extended benefits are available only for Covered Expenses due to the
disabling condition that are Incurred within the year following the year in which disability begins or no longer
eligible for Plan coverage. The person must remain totally disabled to be eligible for this limited extended
coverage. This extended coverage ends on earliest of the following events:
1. The date the Covered Person is no longer disabled;
2. The end of the year following the year disability began or Plan eligibility otherwise ended;
3. Maximum benefits paid; or
4. The date the disabled person becomes eligible under another group health plan.
For the Employee, Total Disability means that he or she can't perform the main duties of his or her occupation.
For Dependents, it means that the covered Dependent can't perform the normal activities of someone of like
age. Evidence of Total Disability may be requested by SSMC before extended coverage is approved. Benefits
under this title are not available for expenses due to other conditions or for expenses Incurred by persons other
than the disabled person.
G. Continuing Coverage Under USERRA
The SSMC Human Resources Office must be notified, in writing (in advance when practical), should your eligible
employment stop due to active United States Military Service. The SSMC Human Resources Department can provide
full details concerning Employee rights under USERRA and the costs to continue coverage while on active military
duty. The following information is a brief summary. This Plan excludes health expenses resulting from Injuries or
sickness Incurred while on military duty. This Plan excludes any Illness or Injury caused by or resulting from military
service.
SSMC must comply wit h the terms of the Uniformed Services Employment and Reemployment Rights Act
(USERRA), a federal law. This law gives Employees certain rights concerning employment and health
continuation should they meet the USERRA requirements. In general, eligible Employees whose coverage
would stop due to active United States Military Service have the right to continue Plan coverage for up to 18
months or for the period of military service (whichever is shorter). To maintain coverage, the Employee may
be required to pay a monthly Participation Payment up to 102% of the full premium equivalent for individual or
family coverage. However, if the active service is less than 30 days, he or she will not be required to pay more
than the normal Participation Payment, if any. In addition, eligible Employees are entitled to immediate
eligibility for Plan enrollment and coverage when he or she meets the requirements of USERRA. Should you
return to work when military service ends, the SSMC Human Resources Department can provide full details
concerning your eligibility for immediate enrollment and Plan coverage according to USERRA regulations.
