APC General Information

Generally, your benefit election under the Health Alliance health and income protection plans are irrevocable until the next annual enrollment period unless you experience a change in status that qualifies under the law, referred to in this section as a work/life event. In addition, you may make special mid-year election changes to the Medical Plan if you are entitled to Special Enrollment Rights that are discussed at the end of this General Information section. In compliance with federal regulations, associates are given a maximum of 30 days following eligibility to apply for benefits or make changes to benefit elections.

The following guidelines explain enrollment deadlines and effective dates of coverage for newly hired associates and individuals experiencing a work/life event:

An application for coverage must be in writing on a form that the Health Alliance provides for this purpose. If an associate becomes eligible for benefits on or before the 15th day of a calendar month and application for benefits is received in the human resources department by the 15th day of that calendar month (within the 30-day period), benefits will begin on the first day of the following month. If an associate is eligible for benefits after the 15th day of a calendar month and, or application for benefits is received in human resources after the 15th day (from day 16 through day 31) of that calendar month, coverage begins on the first day of the second month. Example A: Associate hired on July 1 has until July 31 to return benefit enrollment materials to human resources. If the papers are received by the close of business on July 15, the associate’s benefits become effective on Aug. 1. However, if the associate does not return the paperwork until July 16, the effective date for benefits will be Sept. 1. Example B: Associate is hired on July 16 and returns benefit enrollment materials the same day. The associate’s benefits become effective on Sept. 1. In order to avoid missing a deadline, take into consideration your human resources department’s normal hours of operation. See the “Information Concerning Special Enrollment Rights” section for specific exceptions to the above timing rule.

Terminated associates who return to active status within six months of termination from the Health Alliance and who meet the Health Alliance’s definition of a “Rehire” are eligible to participate in benefits on the first day of the month following re-employment, as long as their benefit enrollment materials are received by human resources no later than the last day in the month in which the associate returned to work. The standard rule to submit benefit forms to human resources by the 15th day of the month in order to receive benefits on the first day of the following month does not apply. However, in order to avoid owing back payments for benefits, submitting benefit enrollment forms to human resources as early as possible is recommended.

Work/Life Events
All Health Alliance benefit elections you make are irrevocable until the next annual enrollment period unless you experience a work/life event. You will be entitled to make mid-year changes to your benefit elections that are consistent with the following work/life events:

• A change in your legal marital status, including marriage, death of spouse, divorce, legal separation, and annulment
• A change in the number of your dependents due to birth, death, adoption, placement for adoption and legal guardianship
• A change in your employment status from benefits-ineligible status to benefits-eligible status, or benefits-eligible status to benefits-ineligible status
• A change in the employment status of your spouse or dependent that affects eligibility in their benefits (this includes the start or end of employment, a change in hours, a strike or lockout, a change in worksite locations, and commencement or return from an unpaid leave of absence)
• A dependent satisfies (or ceases to satisfy) dependent eligibility requirements
• A change in your residence or the residence of your spouse or dependent that affects eligibility for coverage. This applies to members relocating at least 50 miles outside the service location area
• A significant reduction or improvement of coverage or a significant change in cost of the Plan
• Different benefit enrollment periods for you and your spouse. Application for changes to Health Alliance benefits must occur during the same time as your spouse’s benefit enrollment period
• A change covered by the Family and Medical Leave Act
• A change with respect to a judgment, decree or court order
• A change in your or your dependent’s eligibility for Medicare or Medicaid
• An event listed in the “Information Concerning Special Enrollment Rights” section.

Remember that any mid-year change to your benefit elections due to a work / life event must be consistent with the work / life event. For example, if you marry, you may enroll your spouse in benefits. However, you may not cancel your dependents from coverage without an event that affects them. A work/life event involving a domestic partner is not recognized under existing law and therefore does not entitle you to mid-year changes to your benefit elections.

Circumstances That May Affect Your
Dependent Care Flexible Spending Account
There are additional circumstances that permit mid-year election changes for associates enrolled in a dependent care flexible spending account. They include a change in the number of individuals eligible to use the benefit; a change in your dependent care provider; a change in the cost for care by a non-relative provider; and a change in a parent’s work schedule.

Information Concerning Special Enrollment Rights
There are special enrollment rights with special effective dates for medical insurance coverage for associates and their dependents who lose medical insurance coverage under another plan if the following criteria are satisfied:

• The associate declined coverage with the Health Alliance because they were covered under another group health plan or had other health insurance coverage, including COBRA, at the time they denied coverage under the Plan; and
• The associate and/or their dependent lost coverage due to ineligibility. This includes the expiration of COBRA, loss of employer contributions toward the other coverage, loss of coverage as a result of legal separation, divorce, death, termination of employment, or reduction in the number of hours of employment.Note: the loss of coverage due to failure to pay premiums on a timely basis or termination due to fraudulent claims or intentional misrepresentation does not qualify for special enrollment rights.

Even if you currently don’t have medical coverage with the Health Alliance, there are special enrollment rights and special effective dates for medical insurance coverage with respect to the following events:

• Marriage
• Birth of a baby
• Adoption or placement of a child for adoption.

Effective dates of coverage for associates eligible for special enrollment rights due to a loss of medical insurance coverage or due to marriage:

*If an application for benefits is received in the human resources department on any day of a calendar month, within 30 days following the event, benefits will begin on the first day of the calendar month beginning after the date the completed request for enrollment is received.

Effective dates of coverage for associates eligible for special enrollment rights due to birth of baby, adoption or placement of child for adoption:

*If an application for benefits is received in the human resources department on any day within 30 days following the event, benefits will begin retroactively as of the baby’s birth, date of adoption or date the placement for adoption occurred.

*In order to avoid owing back payments for benefits, we recommend that associates submit their benefit changes to the human resources department by the 15th day of the month prior to the effective date of coverage, whenever possible.

Turning in your Completed Benefits Enrollment and Change Form
For enrollments or changes in benefits, you must return the completed form no later than the end of the enrollment period in order to have coverage. Forms should be hand delivered to your human resources department to ensure you are meeting the deadline.

Please print legibly and provide all requested information to ensure prompt processing of your elections. Press firmly and be sure that all copies are legible.

Be sure to sign and date the benefits enrollment form before returning it to your human resources department. Retain a copy that is signed and dated by a human resources representative for your files.

Pay Schedule
Most Health Alliance associates are paid on a bi-weekly basis – 26 times a year – for hours worked in the two-week period beginning on a Sunday and ending on the Saturday before the pay date. Deductions for the plans in which you participate will be withheld from all paychecks dated during a month in which benefits are active. This includes final PTO payout checks.

Coverage Effective Date
This chart outlines the coverage effective dates for the plans outlined here.

What Happens Next
Deductions for the coverage you have selected will be withheld starting with your first pay in January of the new year. (If you are a newly hired associate, the deductions will be taken from your first pay in the month your benefits become effective.) You will also receive medical ID cards mailed to your home for new coverage that you selected. Summary plan descriptions or certificates of coverage are available in the Health Alliance Benefits department. To request a copy of these materials, please call (513) 585-6060. You can also reach us in GroupWise at the address "Alliance Benefits" or e-mail us form home at benefits@healthall.com.

This web site provides a summary of your options under the Health Alliance benefit program: medical, dental, FSA and supplemental insurances as well as many benefits provided to you at no cost. If you have unanswered questions, you may contact your Human Resources Benefits department at 513-585-6060. You can also reach us in GroupWise at the address "Alliance Benefits".

This site is intended to provide a helpful overview that you can use in making your benefit choices. The web site does not provide a detailed description of each plan. Please read carefully. If there is a discrepancy between this site and the official plan documents, the official documents govern.

The Health Alliance’s benefits practices are separate from its employment practices. Your participation in a Health Alliance benefit plan is not a contract or a guarantee of employment. No statement on this web site is intended as a contractual commitment of the Health Alliance to any participant.

The Health Alliance reviews its benefits plans regularly and reserves the right to change or end any plan at any time.