UC2004 View Datasheet(PDF) - Unspecified

Part Name

Description

Manufacturer

UC2004

Behavioral Health Benefits for Blue Cross PLUS

Unspecified 

ENROLLMENT

For information about enrolling yourself or an eligible Family Member, see the person at your location who handles

benefits. If you are an Annuitant, contact the University's Customer Service Center. Enrollment transactions may be

completed by paper form or electronically, according to current University practice. To complete the enrollment

transaction, paper forms must be received by the local Accounting or Benefits office or by the University's Customer

Service Center by the last business day within the applicable enrollment period; electronic transactions must be

completed by midnight of the last day of the enrollment period.

During a Period of Initial Eligibility (PIE)

A PIE ends 31 days after it begins.

If you are an Employee, you may enroll yourself and any eligible Family Members during your PIE. Your PIE starts the

day you become an eligible Employee.

You may enroll any newly eligible Family Member during his or her PIE. The Family Member's PIE starts the day your

Family Member becomes eligible, as described below. During this PIE you may also enroll yourself and/or any other

eligible Family Member if not enrolled during your own or their own PIE. You must enroll yourself in order to enroll

any eligible Family Member. Family members are only eligible for the same plan you are enrolled in.

(a) For a spouse, on the date of marriage.

(b) For a natural child, on the child's date of birth.

(c) For an adopted child, the earlier of:

(i) the date you or your Spouse has the legal right to control the child's health care, or

(ii) the date the child is placed in your physical custody.

If the child is not enrolled during the PIE beginning on that date, there is an additional PIE beginning on the

date the adoption becomes final.

(d) Where there is more than one eligibility requirement, the date all requirements are satisfied.

If you decline enrollment for yourself or your eligible Family Members because of other group medical plan coverage

and you lose that coverage involuntarily, you may be able to enroll yourself and those eligible Family Members during

a PIE that starts on the day the other coverage is no longer in effect.

If you are in an HMO, POS or EPO Plan and you move or are transferred out of that Plan’s service area, or will be away

from the Plan’s service area for more than two months, you will have a PIE to enroll yourself and your eligible Family

Members in another University medical plan. Your PIE starts with the effective date of the move or the date you leave

the Plan’s service area.

At Other Times For Employees And Annuitants

You and your eligible Family Members may also enroll during a group open enrollment period established by the

University.

If you opt out of medical coverage or fail to enroll yourself or your eligible Family Members during a PIE or open

enrollment period, you may enroll yourself and/or eligible Family Members at any other time upon completion of a 90

consecutive calendar day waiting period. The 90-day waiting period starts on the date the enrollment form is received

by the local Accounting or Benefits office and ends 90 consecutive calendar days later.

If you have two or more Family Members enrolled in the Plan, you may add a newly eligible Child at any time. See

"Effective Date".

If you are an Annuitant, you may continue coverage for yourself and your enrolled Family Members in the same plan

you were enrolled in immediately before retiring. You must elect to continue enrollment for yourself and enrolled

Family Members before the effective date of retirement (or the date disability or survivor benefits begin).

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