[CONVERSION RIGHTS FOR DIVORCED SPOUSES IF AN EMPLOYEE'S MARRIAGE OR CIVIL [OR DOMESTIC PARTNERSHIP] ENDS If an Employee's marriage ends by legal divorce or annulment or the employee’s civil union is dissolved [or termination of the domestic partnership], the group health benefits for his or her former spouse ends. The former spouse may convert to an individual major medical policy during the conversion period. The former spouse may insure under his or her individual policy any of his or her Dependent children who were insured under this Policy on the date the group health benefits ends. See exceptions below. Exceptions No former spouse may use this conversion right: if he or she is eligible for Medicare; or if it would cause him or her to be overinsured. This may happen if the spouse is covered or eligible for coverage providing similar benefits provided by any other plan, insured or not insured. [Carrier] will determine if overinsurance exists using its standards for overinsurance. HOW AND WHEN TO CONVERT The conversion period means the 31 days after the date group health benefits ends. The former spouse must apply for the individual policy in writing and pay the first premium for such policy during the conversion period. Evidence of insurability will not be required. THE CONVERTED POLICY The individual policy will provide the medical benefits that [Carrier] is required to offer in the state where the Employer is located. The individual policy will take effect on the day after group health benefits under this Policy ends. After group health benefits under this Policy ends, the former spouse and any children covered under the individual policy may still be paid benefits under this Policy. If so, benefits to be paid under the individual policy will be reduced by the amount paid under this Policy.] EFFECT OF INTERACTION WITH A HEALTH MAINTENANCE ORGANIZATION PLAN HEALTH MAINTENANCE ORGANIZATION ("HMO") means a prepaid alternative health care delivery system.
[CONVERSION RIGHTS FOR DIVORCED SPOUSES IF AN EMPLOYEE'S MARRIAGE OR CIVIL [OR DOMESTIC PARTNERSHIP] ENDS If an Employee's marriage ends by legal divorce or annulment or the employee’s civil union is dissolved [or termination of the domestic partnership], the group health benefits for his or her former spouse ends. The former spouse may convert to an individual major medical policy during the conversion period. The former spouse may insure under his or her individual policy any of his or her Dependent children who were insured under this Policy on the date the group health benefits ends. See exceptions below. Exceptions No former spouse may use this conversion right: if he or she is eligible for Medicare; or if it would cause him or her to be overinsured. This may happen if the spouse is covered or eligible for coverage providing similar benefits provided by any other plan, insured or not insured. [Carrier] will determine if overinsurance exists using its standards for overinsurance. HOW AND WHEN TO CONVERT The conversion period means the 31 days after the date group health benefits ends. The former spouse must apply for the individual policy in writing and pay the first premium for such policy during the conversion period. Evidence of insurability will not be required. THE CONVERTED POLICY The individual policy will provide the medical benefits that [Carrier] is required to offer in the state where the Employer is located. The individual policy will take effect on the day after group health benefits under this Policy ends. After group health benefits under this Policy ends, the former spouse and any children covered under the individual policy may still be paid benefits under this Policy. If so, benefits to be paid under the individual policy will be reduced by the amount paid under this Policy.] EFFECT OF INTERACTION WITH A HEALTH MAINTENANCE ORGANIZATION PLAN HEALTH MAINTENANCE ORGANIZATION ("HMO") means a prepaid alternative health care delivery system.
policyb_e.docx